2012版KDIGO-AKI诊疗指南论述.ppt

Conceptual model for AKI Guideline 2：临床评估 2.1 详细的病史采集和体格检查有助于AKI病因的判断(1A) 2.2 24小时之内进行基本的检查，包括尿液分析和泌尿系超声(怀疑有尿路梗阻者)(1A) Chapter 2.2: Risk assessment Chapter 2.2: Risk assessment ?AKI is defined as any of the following (Not Graded ):  ·AKI is defined as any of the following (Not Graded ): KIncrease in SCr by X 0.3 mg/dl ( X26.5 lmol/l)within 48 hours; ·or KIncrease in SCr to X1.5 times baseline, whichis known or presumed to have occurred withinthe prior 7 days;  ·orKUrine volume o0.5 ml/kg/h for 6 hours.?Test patients at increased risk for AKI with measurements of SCr and urine output to detect AKI. ( Not Graded )?Individualize frequency and duration of monitoring based on patient risk and clinical course. ( Not Graded )? Evaluate patients with AKI promptly to determine the cause, with special attention to reversible causes.(Not Graded ) ? he cause of AKI should be determined whenever possible. (Not Graded) Definition and staging of AKI Overview of AKI, CKD, and AKD. Overlapping ovals show the relationships among AKI, AKD, and CKD. AKI is a subset of AKD. Both AKI and AKD without AKI can be superimposed upon CKD. Individuals without AKI, AKD, or CKD have no known kidney disease (NKD), not shown here. AKD, acute kidney diseases and disorders; AKI, acute kidney injury; CKD, chronic kidney disease. AKDacute kidney diseases and disorder 符合以下任何一项 AKI, 符合AKI定义 3个月内在原来基础上，GFR下降35%或Scr上升50% GFR60ml/min/1.73m2, 3个月 肾损伤3个月 AKI/CKD/AKD 肾功能改变 肾脏结构改变 AKI 7天内血肌酐升高50% 2天内血肌酐升高0.3mg/dl 少尿 CKD GFR60ml/min/1.73m2 3个月 3个月 AKD AKI 3个月内在原来基础上，GFR下降35%或Scr上升50% GFR60ml/min/1.73m2, 3个月 3个月 NKD 无异常 Guideline 3：Prevention and Treatment of AKI 3.1评估危险因素(1B) 年龄75岁 CKD (eGFR60ml/min/1.73m2 心力衰竭 动脉粥样硬化性周围血管病变 肝脏疾病 糖尿病 肾毒性药物的使用 低血容量 感染 3.2评估容量状态后适当补液(1B) HIGH RISK 3.3造影剂肾病 3.4继发于横纹肌溶解的AKI 给予0.9%氯化钠和碳酸氢钠扩容(1B) 对具CI-AKI高风险者： 建议采用等渗或低渗造影剂 建议口服或静脉使用N?-乙酰半胱氨酸（NAC）及等渗晶体预防CI-AKI 推荐使用等渗氯化钠或碳酸氢钠静脉扩容以预防CI-AKI　 Guideline 4：AKI的治疗 一般治疗(1A) Stage-based management of AKI Chapte