急性肾损伤(AKI)是临床常见危重病症,发病率不断升高,死亡率居高不下,防治形势极为严峻。 由于危重AKI 死亡率很高,因此预防发病和阻止病情进展是AKI 防治的重要环节。 不同病因和不同类型AKI,预防和治疗方法不同,总的原则是尽早识别并纠正可逆性病因,在AKI 起始期及时干预能最大限度减轻肾脏损伤,促进肾功能恢复;加强支持对症治疗,酌情限制水、钠和钾的摄入,维持水、电解质和酸碱平衡,适当营养支持,可优先通过胃肠道提供营养;积极防治并发症;重症AKI 患者应适时开始肾脏替代疗法(RRT),应针对临床具体情况,明确患者的治疗需求和RRT 治疗目标,权衡利弊,综合决定RRT 开始时机、剂量及模式,并在治疗期间及时调整治疗方案,实行目标导向的个体化肾脏替代策略。

Acute kidney injury (AKI) is clinically a common critical disease, whose incidence increases continually with the mortality being high. The situation for prevention and treatment of AKI is very rigorous. Due to the high mortality of patients with AKI, prevention of morbidity and disease progression is a very important part of the prevention and treatment of AKI. Different causes and types of AKI result in different methods of AKI management. The main principle of AKI management is identifying and correcting the reversible causes as early as possible. Timely intervention at the initiation of AKI may be able to alleviate the kidney injury as much as possible, promoting the recovery of renal functions. Symptomatic treatment should be strengthened, and the intake of fluid and sodium and potassium be restricted so as to maintain the volume, electrolyte and acid-base balance. Nutrition support should also be given through the gastrointestinal tract first, and different kinds of complications should be prevented and treated actively. Critical AKI patients should be treated with renal replacement therapy (RRT). To implement goal-oriented individual renal replacement strategy, we should first make clear the treatment needs of patients as well as the goals of RRT according to specific clinical situations;Then,after weighing the advantages and disadvantages,we can make a comprehensive decision for the RRT start timing, dosage and mode. Besides, we should also make timely adjustments of regimen according to the effects during RRT.