RECOGNIZING AND MANAGING ACUTE KIDNEY INJURY

摘要

Acute, intrinsic renal failure (ARF) is the abrupt, sustained decline in glomerular filtration resulting in azotemia. The kidneys are uniquely susceptible to acute damage due to the large volume of blood filtered for each cardiac cycle, regional differences in blood supply within the kidney, and a high rate of metabolic activity of renal tubular cells. In critical illness, ARF occurs from ischemic events, nephrotoxicity, hypovolemia, drugs, or secondary to the systemic inflammatory response. Common events predisposing to ARF are listed in Table 1.Development of acute kidney injury occurs through a series of steps that include initiation, extension, maintenance, and recovery. The initiation phase occurs with exposure to the toxicant or the ischemic event. Extension occurs during the response to injury and the subsequent renal damage that exacerbates the response to the initial insult. Recognizing the possibility of renal injury and administering appropriate therapy during the initiation phase prevents the establishment of ARF or lessens the severity of injury. The maintenance phase consists of established tubular lesions and nephron dysfunction. The recovery phase occurs with nephron repair and return to function, with compensatory hypertrophy of the remaining functional nephrons. In general, renal recovery occurs over 6-8 weeks following establishment of renal failure.