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中华肾病研究电子杂志 ›› 2019, Vol. 08 ›› Issue (04) : 145 -149. doi: 10.3877/cma.j.issn.2095-3216.2019.04.001

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急性肾损伤的诊断和早期预警
王利华,1, 苏晓乐1   
  1. 1. 030001 山西医科大学第二医院肾内科
  • 收稿日期:2018-11-09 出版日期:2019-08-28
  • 通信作者: 王利华

Diagnosis and early alert for acute kidney injury

Lihua Wang,1, Xiaole Su1   

  1. 1. Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2018-11-09 Published:2019-08-28
  • Corresponding author: Lihua Wang
  • About author:
    Corresponding author: Wang Lihua, Email:
引用本文:

王利华, 苏晓乐. 急性肾损伤的诊断和早期预警[J/OL]. 中华肾病研究电子杂志, 2019, 08(04): 145-149.

Lihua Wang, Xiaole Su. Diagnosis and early alert for acute kidney injury[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(04): 145-149.

急性肾损伤(AKI)是临床常见的急危重症,涉及多学科,预后较差。但该病在临床工作中,仍存在较高的漏诊率和治疗不足。改善AKI预后的关键是疾病的早期诊断。实现AKI的早期诊断首先需要识别高危人群和纠正可逆的危险因素。其次,随着实验技术的发展,一些生物学标志物如肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关性脂质运载蛋白(NGAL)及N-乙酰-β-D-氨基葡萄糖苷酶(NAG)等均能在早期反映肾功能变化,已越来越多的应用于临床中。尿沉渣镜检、多普勒超声阻力指数及近年来报告的便携式荧光分析仪快速测量肾小球滤过率等在AKI的早期诊断中也发挥着重要作用。另外,结合电子健康记录或临床信息系统的AKI电子预警系统,在医疗工作中也越来越受到了临床医生的重视。本文将就辅助AKI早期诊断的上述问题做一讨论。

Acute kidney injury (AKI) is a commonly encountered syndrome associated with high mortality and poor outcomes. With high rate of missed diagnosis and inadequate treatment, AKI has not received as much attention in clinical practice. The key to improve the prognosis of AKI is early diagnosis and intervention. Firstly, there should be careful consideration to identify those people at greatest risk for AKI and treat the modifiable risk factors. Secondly, several biomarkers of AKI, which can reflect the early changes of the kidney function, such as kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, urinary N-acetyl-β-D-glucosaminidase, and so on, have been applied to clinical practice. Other methods of accessory examination, including urine microscopy, Doppler-based renal arterial resistive index, and quick measurement of GFR based on portable fluorescence analyzer, were also reported to play important roles in the early diagnosis of AKI. Lastly, combined with electronic health records and clinical information system, the electronic alert system for AKI has aroused great concern among clinicians and been applied to the practical management of AKI gradually. This article reviewed the above issues for assisting AKI early diagnosis.

表1 AKI诊断和分期[6]
表2 中低收入国家中AKI的危险因素[9]
图1 AKI电子预警平台简易工作流程[25]
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