急性肾衰竭与急性肾损伤-0204复习课程课件

急性肾衰竭与急性垮损伤20190204急性肾衰竭与急性垮损伤1AcuteKidneyInjury,Mortality,Lengthofstay,andCostsinHospitalizedPatientJAmSocNephrol16:3365-3370,2019100304050910-19SCr(mg/dLChertow等研究表明,血肌酐上升26.5moL可使病死率上升4.1倍。大量临床研究显示,肾功能轻度损伤即可导致AKI发病率及病死率的增加。AcuteKidneyInjury,Mortality2Table1Hospital-acquiredAKl:mortalityandcostassociatedwithselectedchangesinSCrIncreaseinSCrMultivariableorAreaunderIncreasein(mg/dl(95%C)RoCcurvetotalcost0.341(3.1-5.5)0.840565(5.08.5)0.86574991.097(71-13.2)s132002.0164410.3-26)s22023AKl,acutekidneyinjury;Cl,confidenceinterval;OR,oddsratio;ROC,receivingoperatingcharacteristiC;SCr,serumcreatinine住院患者血肌酐的轻微改变即与死亡风险和治疗费用相关ChertowGMetal.JAmSocNephrol2019:16:3365-3370Table1Hospital-acquiredAKl:3AKI的定义令1951年,Homerwsmith首次引入了“急性肾衰竭acuterenalfailure,ARF)”这一概念。心近年的研究表明,住院患者血肌酐的轻微改变即与不良预后相关◆近年来国际肾脏病及重症医学界使用急性肾损伤(acutekidneyinjury)替代急性肾衰竭。2019年急性肾损伤网终(acutekidneyinjurynetwork,AKIN)于荷兰阿姆斯特丹召开了急性肾衰竭研讨会,建议将ARF改名为AKI。心AKIN将AKI定义为:AKI是指不超过3个月的肾脏结构或功能的异常,包括血、尿、组织检测或影像学方面的肾损伤标志物的异常或肾小球滤过率小于60ml/(min1.73m2)ASoeNephron19:604-60620195:osteEAetal.CriticalCare.10(3):1-102019:RabbHJAKI的定义4aboutakiguidelineadQI(AcuteDialysisQualityInitiative):2019,RIFLEAKIN:2019,modifieddefinitionandstagingsystem.KDIGO:2019,FirstclinicalguidelineforAKIAKIguidelineforAKI:2019UKRenalassociationfinalversion08.03.11.gAKIguidline--KDIGO2019aboutakiguideline5◆在ICU中,AKI的发病率逐年增加,急性肾损伤的严重程度和病死率密切相关。◆在ICU中,AKI的发病率逐年增加,急性肾损伤的严6AKI的发生率和死亡率IncidenceandmortalityofacutekidneyinjuryinselectAuthorSottingDefinitionofaklIncidence-hospitalmortalitySepsisSCrincreaseto2mg/dLNoAKl:2.72%:AKIDmissionsSCrrisefor≤10tAKAD:II%AKE57%Neveu"ICUadmissionswithinSCrto23.5ma/clAKIfromsepsis.74%N2100mg/dLor100%AsepticAKI:45%SCrincreaseto>2mg/dn%t46%,dependingsepsis/SIRS(N-2,527needfordialysis,ordoubingofsomortalitynotreportedPercutaneouscoronaryvarerIncreaseinSCr>0.5mg/dNoAKk:06PCN=8357IncreaseinSCr225%or20.5mg/dLAKE13%ThatsIncreaseinSCr20.5mg/dLIAK:3.3%:AKHD:0.3%AKE22%:NoAKI:1%McCullough"PCI(N-1,826)IncreaseinSCrs25%AKLD:0.8%6AK上7%;AKDD:36%chelacreaseinSCr>25%AKE4%ofentit22cfthosewih2SONotreporteremergencydeptN=1,224]measurementAKD:0%cIncreaseinSCr>%AKlinDMCKD:2.4%NotreportedAKinIVcontast:2.1%Notreportedtoatleast1.2mg/dAKnⅣcontrast:I.3%WaikarSSetal.ClinJAmSeeNephrol2019:3:844-861AKI的发生率和死亡率7AKI的发生率和死亡率CardiacsurgeryMehtaNeedfordialysisortedNoAKID:23%AKHD:43.6%itsundergoingCABGncreasein25%25-49%2-4%:19o,2100N=1.391≥100%:5%25-4%%18N=643=:(3AKl:notreportedN=19.89AKID:1.79IncreaseinSCr%AK:3.4%NoAKAKID:1.99IncreaseinSCr220%withinAK:15.6%NAK:1.0%N=591AKID:1.4%AK:120%;AD375%Chertow"5CABGorvalvularsurgeryNeedfordiabyAKHD:II%(30daymortalityN-43,642paredManganoCABGorvalvularsurgeryeaseinSCrcf20.7mg/dLN。AK:0y%=2222loatleast2.0mg/dLAKH:1.47AK:1%AXD:63.8%AKI的发生率和死亡率8AKI的发生率和死亡率Incidenceandmortalityofacutekidneyinjuryinselectedconditions(continuedDefinitionofAKcidenceIn-hospitalmortalityiodcmaninoatbaselineAKI,gentamicin.26.3%Bates585seinSCrcf>%toalAK:14SCratleast3.0mg/dL)aspergillosis(N=2391AKD:145%AKID:76%0atheyAminoglycosides(N-243)IncreaseinSCrcf0.5mg/dLNotreportedand100%soverbaselineSmit"GentamicinandAK:19.2%PrintslncreaseinSCrcf220%6AKl:13%bomgroups)NotreportedAKHD:notreportedIncreaseinSCrof>20%AK-12%IncreaseinSCrto>1.7mg/dLdominalaorticsurgeryor30%overbaselineAKD:569AKI的发生率和死亡率9二、病因和分类肾前性:◆大出血、消化道或皮肤大量失液、液体向第三间隙转移、过渡利尿引起急性血容量不足◆充血性心力衰竭、急性心肌梗死、严重心律失常、心脏压塞、肺栓塞等所致心排量降低;◆全身性疾病、Sepsis、过敏反应等引起有效循环血量减少或重分布,肾血管病变或药物引起的肾血管阻力增加等病因→肾血流低灌注→肾小球滤过率不能维持正常→少尿。早期功能性。二、病因和分类10急性肾衰竭与急性肾损伤——0204复习课程课件11急性肾衰竭与急性肾损伤——0204复习课程课件12急性肾衰竭与急性肾损伤——0204复习课程课件13急性肾衰竭与急性肾损伤——0204复习课程课件14急性肾衰竭与急性肾损伤——0204复习课程课件15急性肾衰竭与急性肾损伤——0204复习课程课件16急性肾衰竭与急性肾损伤——0204复习课程课件17急性肾衰竭与急性肾损伤——0204复习课程课件18急性肾衰竭与急性肾损伤——0204复习课程课件19急性肾衰竭与急性肾损伤——0204复习课程课件20急性肾衰竭与急性肾损伤——0204复习课程课件21急性肾衰竭与急性肾损伤——0204复习课程课件22急性肾衰竭与急性肾损伤——0204复习课程课件23急性肾衰竭与急性肾损伤——0204复习课程课件24急性肾衰竭与急性肾损伤——0204复习课程课件25急性肾衰竭与急性肾损伤——0204复习课程课件26急性肾衰竭与急性肾损伤——0204复习课程课件27急性肾衰竭与急性肾损伤——0204复习课程课件28急性肾衰竭与急性肾损伤——0204复习课程课件29急性肾衰竭与急性肾损伤——0204复习课程课件30急性肾衰竭与急性肾损伤——0204复习课程课件31急性肾衰竭与急性肾损伤——0204复习课程课件32急性肾衰竭与急性肾损伤——0204复习课程课件33急性肾衰竭与急性肾损伤——0204复习课程课件34急性肾衰竭与急性肾损伤——0204复习课程课件35急性肾衰竭与急性肾损伤——0204复习课程课件36急性肾衰竭与急性肾损伤——0204复习课程课件37急性肾衰竭与急性肾损伤——0204复习课程课件38急性肾衰竭与急性肾损伤——0204复习课程课件39急性肾衰竭与急性肾损伤——0204复习课程课件40急性肾衰竭与急性肾损伤——0204复习课程课件41急性肾衰竭与急性肾损伤——0204复习课程课件42急性肾衰竭与急性肾损伤——0204复习课程课件43急性肾衰竭与急性肾损伤——0204复习课程课件44急性肾衰竭与急性肾损伤——0204复习课程课件45急性肾衰竭与急性肾损伤——0204复习课程课件46急性肾衰竭与急性肾损伤——0204复习课程课件47急性肾衰竭与急性肾损伤——0204复习课程课件48急性肾衰竭与急性肾损伤——0204复习课程课件49急性肾衰竭与急性肾损伤——0204复习课程课件50急性肾衰竭与急性肾损伤——0204复习课程课件51急性肾衰竭与急性肾损伤——0204复习课程课件52急性肾衰竭与急性肾损伤——0204复习课程课件53急性肾衰竭与急性垮损伤20190204急性肾衰竭与急性垮损伤54AcuteKidneyInjury,Mortality,Lengthofstay,andCostsinHospitalizedPatientJAmSocNephrol16:3365-3370,2019100304050910-19SCr(mg/dLChertow等研究表明,血肌酐上升26.5moL可使病死率上升4.1倍。大量临床研究显示,肾功能轻度损伤即可导致AKI发病率及病死率的增加。AcuteKidneyInjury,Mortality55Table1Hospital-acquiredAKl:mortalityandcostassociatedwithselectedchangesinSCrIncreaseinSCrMultivariableorAreaunderIncreasein(mg/dl(95%C)RoCcurvetotalcost0.341(3.1-5.5)0.840565(5.08.5)0.86574991.097(71-13.2)s132002.0164410.3-26)s22023AKl,acutekidneyinjury;Cl,confidenceinterval;OR,oddsratio;ROC,receivingoperatingcharacteristiC;SCr,serumcreatinine住院患者血肌酐的轻微改变即与死亡风险和治疗费用相关ChertowGMetal.JAmSocNephrol2019:16:3365-3370Table1Hospital-acquiredAKl:56AKI的定义令1951年,Homerwsmith首次引入了“急性肾衰竭acuterenalfailure,ARF)”这一概念。心近年的研究表明,住院患者血肌酐的轻微改变即与不良预后相关◆近年来国际肾脏病及重症医学界使用急性肾损伤(acutekidneyinjury)替代急性肾衰竭。2019年急性肾损伤网终(acutekidneyinjurynetwork,AKIN)于荷兰阿姆斯特丹召开了急性肾衰竭研讨会,建议将ARF改名为AKI。心AKIN将AKI定义为:AKI是指不超过3个月的肾脏结构或功能的异常,包括血、尿、组织检测或影像学方面的肾损伤标志物的异常或肾小球滤过率小于60ml/(min1.73m2)ASoeNephron19:604-60620195:osteEAetal.CriticalCare.10(3):1-102019:RabbHJAKI的定义57aboutakiguidelineadQI(AcuteDialysisQualityInitiative):2019,RIFLEAKIN:2019,modifieddefinitionandstagingsystem.KDIGO:2019,FirstclinicalguidelineforAKIAKIguidelineforAKI:2019UKRenalassociationfinalversion08.03.11.gAKIguidline--KDIGO2019aboutakiguideline58◆在ICU中,AKI的发病率逐年增加,急性肾损伤的严重程度和病死率密切相关。◆在ICU中,AKI的发病率逐年增加,急性肾损伤的严59AKI的发生率和死亡率IncidenceandmortalityofacutekidneyinjuryinselectAuthorSottingDefinitionofaklIncidence-hospitalmortalitySepsisSCrincreaseto2mg/dLNoAKl:2.72%:AKIDmissionsSCrrisefor≤10tAKAD:II%AKE57%Neveu"ICUadmissionswithinSCrto23.5ma/clAKIfromsepsis.74%N2100mg/dLor100%AsepticAKI:45%SCrincreaseto>2mg/dn%t46%,dependingsepsis/SIRS(N-2,527needfordialysis,ordoubingofsomortalitynotreportedPercutaneouscoronaryvarerIncreaseinSCr>0.5mg/dNoAKk:06PCN=8357IncreaseinSCr225%or20.5mg/dLAKE13%ThatsIncreaseinSCr20.5mg/dLIAK:3.3%:AKHD:0.3%AKE22%:NoAKI:1%McCullough"PCI(N-1,826)IncreaseinSCrs25%AKLD:0.8%6AK上7%;AKDD:36%chelacreaseinSCr>25%AKE4%ofentit22cfthosewih2SONotreporteremergencydeptN=1,224]measurementAKD:0%cIncreaseinSCr>%AKlinDMCKD:2.4%NotreportedAKinIVcontast:2.1%Notreportedtoatleast1.2mg/dAKnⅣcontrast:I.3%WaikarSSetal.ClinJAmSeeNephrol2019:3:844-861AKI的发生率和死亡率60AKI的发生率和死亡率CardiacsurgeryMehtaNeedfordialysisortedNoAKID:23%AKHD:43.6%itsundergoingCABGncreasein25%25-49%2-4%:19o,2100N=1.391≥100%:5%25-4%%18N=643=:(3AKl:notreportedN=19.89AKID:1.79IncreaseinSCr%AK:3.4%NoAKAKID:1.99IncreaseinSCr220%withinAK:15.6%NAK:1.0%N=591AKID:1.4%AK:120%;AD375%Chertow"5CABGorvalvularsurgeryNeedfordiabyAKHD:II%(30daymortalityN-43,642paredManganoCABGorvalvularsurgeryeaseinSCrcf20.7mg/dLN。AK:0y%=2222loatleast2.0mg/dLAKH:1.47AK:1%AXD:63.8%AKI的发生率和死亡率61AKI的发生率和死亡率Incidenceandmortalityofacutekidneyinjuryinselectedconditions(continuedDefinitionofAKcidenceIn-hospitalmortalityiodcmaninoatbaselineAKI,gentamicin.26.3%Bates585seinSCrcf>%toalAK:14SCratleast3.0mg/dL)aspergillosis(N=2391AKD:145%AKID:76%0atheyAminoglycosides(N-243)IncreaseinSCrcf0.5mg/dLNotreportedand100%soverbaselineSmit"GentamicinandAK:19.2%PrintslncreaseinSCrcf220%6AKl:13%bomgroups)NotreportedAKHD:notreportedIncreaseinSCrof>20%AK-12%IncreaseinSCrto>1.7mg/dLdominalaorticsurgeryor30%overbaselineAKD:569AKI的发生率和死亡率62二、病因和分类肾前性:◆大出血、消化道或皮肤大量失液、液体向第三间隙转移、过渡利尿引起急性血容量不足◆充血性心力衰竭、急性心肌梗死、严重心律失常、心脏压塞、肺栓塞等所致心排量降低;◆全身性疾病、Sepsis、过敏反应等引起有效循环血量减少或重分布,肾血管病变或药物引起的肾血管阻力增加等病因→肾血流低灌注→肾小球滤过率不能维持正常→少尿。早期功能性。二、病因和分类63急性肾衰竭与急性肾损伤——0204复习课程课件64急性肾衰竭与急性肾损伤——0204复习课程课件65急性肾衰竭与急性肾损伤——0204复习课程课件66急性肾衰竭与急性肾损伤——0204复习课程课件67急性肾衰竭与急性肾损伤——0204复习课程课件