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急性肾损伤-急性肾功能衰竭
TheEarlyReportofARF“Thediseaseseemsingeneraltocomeonsuddenly.Thepeculiarsymptomisasuddendiminutionofsecretionofurine,whichsoon amountstoacompletesuspensionofit.Theafflictionisprobablyat firstconsideredasretention;butthecatheterbeingemployed,the bladderisfoundtobeempty...afterseveraldays,thepatient beginstotalkincoherently,andshowsatendencytostupor.This increasesgraduallytoperfectcoma,whichinafewdaysmoreis fatal...”JohnAbercombie(1780–1828)sudden(i.e.,hourstodays)reductioninurinevolume
ProfileRapiddecreaseinrenalfunctionoverdaystoweeks,causingaaccumulationofnitrogenousproductsintheblood.Oftenresultsfrommajortrauma,illness,orsurgerybutinsomecasesiscausedbyarapidlyprogressive,intrinsicrenaldisease.Symptomsincludeanorexia,nausea,andvomiting,progressingtoseizuresandcomaiftheconditionisuntreated.Fluid,electrolyte,andacid-basedisordersdevelopquickly.Diagnosisisbasedonlaboratorytestsofrenalfunction,includingserumcreatinine,renalfailureindex,andurinarysediment.Othertestsareneededtodeterminethecause.Treatmentisdirectedatthecausebutalsoincludesfluidandelectrolytemanagementandsometimesdialysis.
EpidemiologyVariable(inconsistentdefinitions,differentpopulation) Basedonnewdefinition,AKIoccurs approximately7%inhospitalizedpatientsMortality:Variabledependonetiology
TheModernUnderstandingofARFARFtoAKIDefinitionisbasedonabsoluteincreasein serumcreatinine(Scr)andoliguria
NewconceptsinDefinitionWhat’sthenewdefinition?Earlysingle-centerandmulticenterCohortstudies,administrativedatabasestudiesDefinitionsweredifferent Houetal.AmJMed74:243–248,1983
NewconceptsinDefinitionTheSecondInternationalConsensusConferenceoftheAcuteDialysisQualityInitiative(ADQI)Group.CritCare.2004;8:R204
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