Sex steroids in cardiopulmonary bypass 英文参考文献.docVIP

Joannidis and Forni Critical Care 2011,15:223 /content/15/3/223 REVIEW Clinical review: Timing of renal replacement therapy Michael Joannidis* and Lui G Forni 1 2 e cause of the acute kidney injury (AKI) necessitating Abstract RRTis also relevant e unconditional acceptance of Acute kidney injury is common in intensive care patients and continuous renal replacement therapy is the preferred treatment for this in most centres. Although these techniques have been adopted internationally, there remains signi?cant variation with regard to their clinical application. This is particularly pertinent when one considers that the fundamental questions regarding any treatment, such as initiation, dose and length of treatment, remain a source of debate and have not as yet all been fully answered. In this narrative review we consider the timing of renal replacement therapy, highlighting the relative paucity of high quality data regarding this fundamental question. We examine the role of the usual biochemical criteria as well as conventional clinical indications for commencing renal replacement therapy together with the application of recent classi?cation systems, namely RIFLE and AKIN. We discuss the potential role of biomarkers for acute kidney injury as predictors for the need for renal support and discuss commencing therapy for indications other than acute kidney injury. terms such as AKI must be considered together with the underlying aetiology in order to understand the basic pathological processes associated with kidney injury. Without an underlying cause, AKI tells us nothing save an observed disturbance in conventionally measured ‘markers’ of function coupled with reduced urine produc- tion. Clearly, the outcome from AKI in a young patient secondary to an interstitial nephritis is very di? erent from that of an elderly diabetic developing AKI following systemic infection from a ru