2012版KDIGO-AKI诊疗指南.ppt

急性肾损伤诊疗指南解读;急性肾损伤(AKI)与急性肾衰竭(ARF);About AKI guideline;AKI流行病学现状;指南推荐强度;指南推荐强度;Guideline 1：AKI的定义与分期;AKI分期标准;RIFLE分级;Conceptual model for AKI;Guideline 2：临床评估;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);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;AKI/CKD/AKD;Guideline 3：Prevention and Treatment of AKI;3.3造影剂肾病;Guideline 4：AKI的治疗;Stage-based management of AKI;补液治疗;补液治疗： 低血容量者： 重复小剂量补液(250ml晶体液/胶体液） 密切监测CVP和尿量 监测乳酸和碱剩余水平 严重脓毒血症者： 慎用高分子量羟乙基淀粉 ;药物治疗(1B);目前无特殊的药物用于治疗继发于低灌注损伤/脓毒血症的AKI (1B);Chapter 3.4: The use of diuretics in AKI;;;The use of diuretics in AKI;甘露醇;Vasodilator therapy: dopamine,fenoldopam, and natriuretic peptides;;多巴胺---不建议;Glycemic control and nutritional support;Growth factor intervention;Prevention of aminoglycoside- andamphotericin-related AKI;Prevention of aminoglycoside- andamphotericin-related AKI;Other methods of pr