危重病患者AKI的诊断.pptVIP

危重病患者AKI的诊断RIFLEVSAKIN

肾前性肾性肾后性肾血管梗阻间质性肾炎急性肾小管坏死肾移植排异肾小球或肾微血管系统疾病肾小管内沉积及阻塞输尿管膀胱颈尿道低血容量低心排量肾脏全身血管阻力比值改变肾脏对低灌注自身调节功能减退高粘滞血症ICU中AKI的常见病因55-60%

AKI定义差异0.5mg/dlincreaseinSCrwithin48h≥0.3mg/dlincreaseinSCr0.9mg/dlincreaseinSCrifbaselineSCr＜2.0mg/dltoatleast2.0mg/dl,or1.5mg/dlincreaseinSCrifbaselineSCr≥2.0mg/dl(baselinedefinedaslowerofmostrecentSCrinpast3moorlowestvalueduringhospitalization)‘Sudden’riseof＞2mg/dlinsubjectswithprior‘normal’renalfuncion,or‘sudden’increaseinSCrof≥50%with‘mildtomoderate’basalchronicrenalfailurewithSCr＜3.0mg/dl,or‘elevationofSCratadmissionwithnormalorincreasedrenalsize(exceptwithmyelomaorhydronephrosiswithcorticalatrophy)’50%increaseinSCrtoatleastSCrof2.0mg/dl(‘ARF’);100%increaseinSCrtoatleastSCrof3.0mg/dl(‘severeARF’)25%increaseinSCrtoatleastSCrof2.0mg/dlwithintwodays0.9mg/dlincreaseinSCrifbaselineSCr＜2.0mg/dl,or1.5mg/dlincreaseinSCrifbaselineSCr≥2.0mg/dl,and‘remainedelevatedoratleastoneadditionalconsecutivedetermination’0.5mg/dlincreaseinSCrifbaselineSCr≤1.9mg/dl,or1.0mg/dlincreaseinSCrifbaselineSCr2.0to4.9mg/dl,or1.5mg/dlincreaseinSCrifbaselineSCr≥5.0mg/dl0.5mg/dlincreaseinSCrtoatleast2.0mg/dl,oradmissionSCr≥2.0mg/dlwithnohistoryofrenaldiseaseSCr≥3.0mg/dlwithbselineSCr＜1.8mg/dl,or‘acutedecrease’increatinineclearanceto≤25ml/minaftersurgery,trauma,hypotension,orsepsis1.0mg/dlincreaseinSCrover2days＞50%increaseinSCrtoatleast1.4mg/dl＞0.3mg/dland＞20%increaseinSCr≥1.0mg/dlincreaseinSCr,or≥20mg/dlor50%increaseinBUN6gradedcriteria＞0.3mg/dland＞20%increaseinSCronday1,2,or3,andday5,6,or7,or＞0.3mg/dlincreaseinSCronday1,2,or3,or＞0.3mg/dland＞20%increaseinSCronday1or2,or≥2.0mg/dlincreaseinSCronday1or2,or≥1.0mg/dlincreasein