文档介绍：急性肾损伤诊断标准进展
2022/5/12
1
前言
急性肾衰竭（ARF）:古老而常新的话题
1802：ischuria renalis（闭尿性肾炎）
1909：Acute Bright’s disease
the First RIFLE标准的Risk,Injury和Failure。
AKIN诊断标准提出
AKI的AKIN诊断标准
Ravindra LM et al. Acute Kidney Injury Network: report of an initiative to improve
outcomes in acute kidney injury. Critical Care 2019, 11:R31
REFLE和AKIN标准比较
应用REFLE和AKIN标准交叉诊断AKI结果比较
The original RIFLE criteria failed to detect 9% of cases that were detected by AKIN criteria.
AKIN criteria missed % of cases detected by RIFLE. Examination of the cases missed by either criteria .
Cases identified by AKIN but missed by RIFLE were almost exclusively Stage 1 (%).
While cases missed by AKIN but identified by RIFLE included 30% with RIFLE-I and 18% RIFLE-F;
These cases had hospital mortality similar to cases identified by both criteria (37% for I and 41% for F).
However, cases missed by RIFLE but identified as Stage 1 by AKIN also had hospital mortality rates nearly twice that of patients who had no evidence of AKI by either criteria (25% vs. 13%).
These data provide strong rationale for use of both RIFLE and AKIN criteria to identify patients with AKI
REFLE和AKIN诊断效能比较
RIFLE及AKIN标准的不足
针对平均体型的成年人，对小体重的儿科患者不合适。
婴儿及儿童肌肉容积小，，针对儿科修订的REFLE AKI标准规定GFR<35ml/。
3期中SCr>，，未限定具体的时间范围。
2019年，国际改善全球肾脏病预后组织（KDIGO）发表了新的AKI指南。
KDIGO指南分为引言和方法学、AKI定义、AKI防治、对比剂AKI、AKI治疗的透析干预5个部分。
指南推荐血清肌酐和尿量仍然作为AKI最好的标志物。
AKI定义：48h以内血Scr增高≧，，且明确或经推断其发生在之前7d之内；或者尿量<，持续6小时。
AKI的KDIGO临床实践指南
KDIGO指南关于AKI分期诊断标准
KDIGO指南关于AKI分期诊断标准
结合了RIFLE与AKIN各自的优势
更加明确与简化增加临床实用性
可能需要进一步的临床评估
Examples of application of AKI definitions
Estimating baseline Scr
Baseline SCr can be estimated using the modification of Diet in Renal Disease (MDRD) Study equation assuming that baseline eGFR is 75 ml/min per
Examples of application of AKI stages
鉴别诊断
Overview of AKI, CKD, and AKD
AKD, acute kidney diseases and disorders;