肝硬化相关急性肾衰竭.pptxVIP

肝硬化相关急性肾衰竭第1页/共11页 Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites第2页/共11页 Leading articleGut Online First, published on January 28, 2015第3页/共11页 The traditional diagnostic criteria1996 yearserum creatinine (sCr) of ≥50% frombaseline to a final value 1.5 mg/dL(133 mmol/L).第4页/共11页 sCr in patients with cirrhosis is affected by(1) decreased formation of creatinine from creatine in muscles, secondaryto muscle wasting; (2) increased renal tubular secretion of creatinine; (3)the increased volume of distribution incirrhosis that may dilute sCr (4) interference with assays for sCr by elevated bilirubin.第5页/共11页 第6页/共11页 Can the reduction of urine output be used as a diagnostic criterion in patients with cirrhosis and ascites ?these patients are frequently oliguric with avid sodium retention and yet may maintain a relativelynormal GFR. Conversely, these patients may have an increased urine output because of diuretic treatment. Thus, urine collection is often inaccurate in clinical practice and the use of kinetic changes in sCr becomes the crux of the definition for the diagnosis of AKI in cirrhosis.第7页/共11页 第8页/共11页 Differences between these new criteria over the conventional criteria in patients with cirrhosis(1) an absolute increase in sCr is considered; (2) the threshold of sCr ≥1.5 mg/dL (133 mmol/L) is abandoned; (3) a staging system of AKI, based ona change in sCr over a slightly longer time frame, arbitrarily set at 1 week to enable assessment for progression of stage (modified from AKIN staging) as well as a regression of stage第9页/共11页 第10页/共11页 感谢您的欣赏第11页/共11页