Acute kidney disease: diagnosis, clinical significance, and status quo implication

doi:10.3877/cma.j.issn.2095-3216.2017.06.004

Abstract

Abstract:

Consensuses on definitions of both acute kidney injury (AKI) and chronic kidney disease (CKD) have been reached, and widely used in researches and clinical practice. Recently people have come to realize that AKI interacts with CKD, which should be regarded as a continuous disease process in some cases. Kidney Disease: Improving Global Outcomes (KDIGO) guidelines have clearly defined AKI as a sharp drop in renal function within 7 days, and CKD as the damage in structure or function of kidneys for more than 90 days. In some AKI patients, the pathophysiological process of renal damage shows no obvious improvement after 7 days. The period of continuous structural impairment of kidneys, secondary to AKI until before the onset of CKD, is defined as acute kidney disease (AKD). Based on the current status of lacking an accurate definition and management strategies for AKD, the Acute Dialysis Quality Initiative (ADQI) Working Group proposed an expert consensus on the definition, staging criteria, and management strategies of AKD so as to promote the awareness of the manifestation and prognosis of AKD.

Key words: Acute kidney disease (AKD), Diagnosis, Clinical significance

Ping Fu, Jing Liu, Xiaoqian Zeng. Acute kidney disease: diagnosis, clinical significance, and status quo implication[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2017, 06(06): 259-266.

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分级I(RIFLE)		SCr/GFR改变			分级Ⅱ (AKIN/KDIGO)	尿量改变
分级I(RIFLE)		RIFLE	AKIN	KDIGO	分级Ⅱ (AKIN/KDIGO)	尿量改变
风险期		血肌酐升至基线1.5～1.9倍；或GFR下降>25%～50%	血肌酐升高≥26.4 μmol/L(0.3 mg/dl)或升至基线150%～200%(1.5～2.0倍)	血肌酐升至基线1.5～1.9倍；或升高≥26.4 μmol/L(0.3 mg/dl)；	1	<0.5 ml/(kg·h)持续6～12 h
损伤期		血肌酐升至基线2.0～2.9倍；或GFR下降>50%～75%	血肌酐升至基线200%～300%(>2～3倍)	血肌酐升至基线2.0～2.9倍	2	<0.5 ml/(kg·h)持续≥12 h
衰竭期		血肌酐增高3倍；或血肌酐>354 μmol/L(4 mg/dl)伴有急性升高>44 μmol/L(0.5 mg/dl)；或GFR下降>75%	血肌酐升至基线300%以上(>3倍)；或在短期升高超过44 Vμmol/L (0.5 mg/dl)的基础上升高至≥354 μmol/L( 4.0 mg/dl)；或开始肾脏替代治疗	血肌酐升至基线3.0倍以上；或升高至≥354 μmol/L (4.0 mg/dl)；或开始肾脏替代治疗；或8岁以下患者eGFR降至35 ml/(min·1.73 m²)以下	3	<0.3 ml/(kg·h)持续≥24 h；或无尿持续≥12 h
结局指标		?	?	?	?	?
?	肾脏功能丧失	持续性急性肾衰竭＝完全性肾功能丧失>4周	/	?	?	?
?	终末期肾病	ESRD>3月	?	?	?	?

分级I(RIFLE)		SCr/GFR改变			分级Ⅱ (AKIN/KDIGO)	尿量改变
分级I(RIFLE)		RIFLE	AKIN	KDIGO	分级Ⅱ (AKIN/KDIGO)	尿量改变
风险期		血肌酐升至基线1.5～1.9倍；或GFR下降>25%～50%	血肌酐升高≥26.4 μmol/L(0.3 mg/dl)或升至基线150%～200%(1.5～2.0倍)	血肌酐升至基线1.5～1.9倍；或升高≥26.4 μmol/L(0.3 mg/dl)；	1	<0.5 ml/(kg·h)持续6～12 h
损伤期		血肌酐升至基线2.0～2.9倍；或GFR下降>50%～75%	血肌酐升至基线200%～300%(>2～3倍)	血肌酐升至基线2.0～2.9倍	2	<0.5 ml/(kg·h)持续≥12 h
衰竭期		血肌酐增高3倍；或血肌酐>354 μmol/L(4 mg/dl)伴有急性升高>44 μmol/L(0.5 mg/dl)；或GFR下降>75%	血肌酐升至基线300%以上(>3倍)；或在短期升高超过44 Vμmol/L (0.5 mg/dl)的基础上升高至≥354 μmol/L( 4.0 mg/dl)；或开始肾脏替代治疗	血肌酐升至基线3.0倍以上；或升高至≥354 μmol/L (4.0 mg/dl)；或开始肾脏替代治疗；或8岁以下患者eGFR降至35 ml/(min·1.73 m²)以下	3	<0.3 ml/(kg·h)持续≥24 h；或无尿持续≥12 h
结局指标		?	?	?	?	?
?	肾脏功能丧失	持续性急性肾衰竭＝完全性肾功能丧失>4周	/	?	?	?
?	终末期肾病	ESRD>3月	?	?	?	?

基线eGFR[ml/(min·1.73 m²)]		连续前7 d内SCr	之后3个月GFR[ml/(min·1.73 m²)]	诊断
?	≥60	>1.5倍	/	AKI
?	≥60	<1.5倍	<60	非AKI的AKD
?	≥60	<1.5倍	≥60	NKD
?	<60	>1.5倍	/	AKI＋CKD
?	<60	<1.5倍	下降>35%	非AKI的AKD＋CKD
?	<60	<1.5倍	下降<35%	CKD

基线eGFR[ml/(min·1.73 m²)]		连续前7 d内SCr	之后3个月GFR[ml/(min·1.73 m²)]	诊断
?	≥60	>1.5倍	/	AKI
?	≥60	<1.5倍	<60	非AKI的AKD
?	≥60	<1.5倍	≥60	NKD
?	<60	>1.5倍	/	AKI＋CKD
?	<60	<1.5倍	下降>35%	非AKI的AKD＋CKD
?	<60	<1.5倍	下降<35%	CKD

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