《Acute Kidney Injury》外科学课件.pptxVIP

Acute Kidney Injury(AKI);Objectives;More than 35 definitions of AKI (formerly acute renal failure) in literature! Mehta R, Chertow G: Acute renal failure definitions and classification: Time for change? Journal of American Society of Nephrology 2003; 14:2178-2187.;Anuria: 100ml/24hr Oliguria: 0.5 mL/kg/hr, or 400ml/24hr Polyuria: 4ml/mg/hr, or 2500ml/24hr SCr/Cr: Serum Creatinine/Creatinine BUN: Blood urea nitrogen RRT: Renal replacement therapy;ATN: Acute tubular necrosis ARF: Acute renal failure GFR: Glomerular filtration rate ICU: Intensive care unit RIFLE: Risk, Injury, Failure, Loss, ESRD ESRD/ESKD: End stage renal/kidney disease AKIN: Acute kidney injury network ;Serum Creatinine Urine Output Time;Increase in SCr by ≥0.3 mg/dl (≥ 26.5μmol/l) within 48 hours; Increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days Urine volume 0.5 ml/kg/h for 6 hours.; ;Stage;Limitations of SCr;Mortality;Mortality increases proportionately with increasing severity of AKI (using RIFLE). AKI requiring RRT is an independent risk factor for in-hospital mortality. Mortality in patients with AKI requiring RRT 50%-70%. Even small changes in SCr are associated with increased mortality. Hoste E, Clermont G, Kersten A, et al.: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Critical Care 2006; 10:R73. Chertow G, Levy E, Hammermeister K, et al.: Independent association between acute renal failure and mortality following cardiac surgery. American Journal of Medicine 1998; 104:343-348. Uchino S, Kellum J, Bellomo R, et al.: Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005; 294:813-818. Coca S, Peixoto A, Garg A, et al.: The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. American Journal of Kidney Diseases 2007; 50:712-720. ; Pre