复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）肾与尿路_AKI

Acute Kidney Injury Yi Fang Department of Nephrology Zhongshan Hospital, Fudan University

Yi Fang Department of Nephrology Zhongshan Hospital, Fudan University Acute Kidney Injury

Acute Kidney Injury, AKI AKI is a common problem, especially in the critical care setting It is a complex disorder for which there was no accepted definition acute renal failure(ARF) fails to adequately describe the dynamic process Reported incidence and mortality varies widely Incidence ranges 1-31% Mortality ranges 28-82% Complications poor prognosIs increased cost, LOS. Increased Damage fallure Death

Acute Kidney Injury, AKI • AKI is a common problem, especially in the critical care setting • It is a complex disorder for which there was no accepted definition • acute renal failure (ARF) fails to adequately describe the dynamic process • Reported incidence and mortality varies widely – Incidence ranges 1-31% – Mortality ranges 28-82% poor prognosis increased cost, LOS……

DEFINITION AND CLASSIFICATION

DEFINITION AND CLASSIFICATION

Definitions of aki and incidence 19.△cr72h>50umoL 20.△cr72h>100umoL 1. Creat△0.1mg/lL 21. Cockcroft-Gault cr cl 30 mL/mi 2. Creat increase >0.5 mg/dL 2. Cockcroft-Gault cr cl 30-60 mL/min2o% 3. Creat>=0.5 mg/dl 4. Creat >=1.7 mg/dl 164% 5. Creat >=1.5 mg/dL 6. Creat >=2 mg/dI 7. Creat>= 2. 1 mg/dL and x 2 30% 8. Creat>=177moL△>62μmoL 9. Creat >200umol/L(2.36 mg/dL) 6.5%6.5 10. Creat> 3.2 mg/dL or x 2 11. Creat>5 mg/dL or K>5.5 10% 12. RIFLE 13. Creat increase > 25% 14. Creat increase > 50% 32. U gluthation transferase-TT crmeazo 15. Creat increase >= 100% 33. U gluthation transferase-a 16.△Cr72h>0umoL 34. NGAL 17.△cr72h>25umoL 35. RRT 18.△Cr72h>44umoL 36

1. Creat Δ 0.1 mg/dL 2. Creat increase >0.5 mg/dL 3. Creat>= 0.5 mg/dL 4. Creat >= 1.7 mg/dL 5. Creat >= 1.5 mg/dL 6. Creat >= 2 mg/dL 7. Creat>= 2.1 mg/dL and x 2 8. Creat >= 177µmol/L Δ>62µmol/L 9. Creat > 200µmol/L (2.36 mg/dL) 10. Creat> 3.2 mg/dL or x 2 11. Creat>5 mg/dL or K > 5.5 12. RIFLE 13. Creat increase >= 25% 14. Creat increase >= 50% 15. Creat increase >= 100% 16. ΔCr72h >0µmol/L 17. ΔCr72h >25µmol/L 18. ΔCr72h >44µmol/L 19. ΔCr72h >50µmol/L 20. ΔCr72h >100µmol/L 21. Cockcroft-Gault Cr Cl < 30 mL/min 22. Cockcroft-Gault Cr Cl 30–60 mL/min 23. ΔCockcroft-Gault72hr <0% 24. ΔCockcroft-Gault72hr <-15% 25. ΔCockcroft-Gault72hr <-25% 26. ΔCockcroft-Gault72hr <-50% 27. MDRD: 50% change in GFR 28. UO <100 q 8hr 29. U α1-microglob 30. U β2- microglobulin 31. U N-acetyl- β-D-glucosaminidase 32. U gluthation transferase-π 33. U gluthation transferase- α 34. NGAL 35. RRT 36. … 4.1% 6.5% 6.5% 9.7% 16.4% 2.0% 4.4% 6.5% 7.9% 0% 10% 20% 30% 40% 50% ≥0.3 mg/dL ≥0.5 mg/dL ≥0.5 mg/dL or ≥1.0 mg/dL* ≥1.0 mg/dL ≥2.0 mg/dL 25% 50% 100% 50% AND creatinine≥2.0 mg/dL AKI (%) 0% 4% 8% 12% 16% 20% Mortality (%) Definitions of AKI and incidence

Current criteria for AKI diagnosis Serum Creatinine Scr Increased UO .25% Urine output Increased creatinine x 2 U075% R( Increase creatinine x1.5 x 24 or >0.3mg/dI Failure or creatinine 2 4mg/dl anuria 12 h (Acute rise of 20.5 mg/dl) Uo≤0.5mkgh (II) Increase creatinine x2 x12h Loss Complete loss of renal function >4 w Increase creatinine x3 UO<3ml/kg/h F(nor creatinine 24mg/dIx24 hr or ESRD End stage renal disease (Acute rise of 20.5 mg/d) Anuria x 12 hrs RRT Started RIFLE criteria AKIN criteria

Current criteria for AKI diagnosis • Serum Creatinine • Urine output Scr Increased creatinine x1.5 or GFR decrease > 25% UO 0.3mg/dl Increase creatinine x2 Increase creatinine x3 or creatinine 4mg/dl (Acute rise of 0.5 mg/dl) UO 75% or creatinine  4mg/dl (Acute rise of 0.5 mg/dl) Complete loss of renal function > 4 w End stage renal disease Risk Injury Failure Loss ESRD

DNEY SLOBAL OUTCOME'e KDIGO CLINICAL PRACTICE GUIDELINE FOR ACUTE KIDNEY INJURY

NEY D O SLOBAL AKI is defined as any of the following(Not Graded: Increase in SCr by 20.3 mg/dl (26.5 umol/I) within 48 hours; or Increase in SCr to >1.5 times baseline which is known or presumed to have occurred within the prior 7 days; or Urine volume <0.5 ml/kg/h for 6 hours

NEY D O oBAL. AKI is staged for severity according to the following criteria (Table 1). (Not graded) Table 1. Staging of AKl Stage Serum creatinine Urine output 15-19 times baseline <0.5 mlkg/h for 6-12 hours ≥03mgdl(≥26.5umo) Increase 2. 0-2.9 times baseline <0.5 ml/kg/h for 212 hours 3.0 times baseline 43m/kg/hfor≥24 hours OR OR Increase in serum creatinine to 24.0 mg/dl Anuria for 212 hours (23536pmo) Initiation of renal replacement therapy OR, In patients <18 years, decrease in eGFR to <35 mI/min per 1.73 m2

INCIDENCE

INCIDENCE

Incidence of AKI in general population 300 0 Crit Care Med, 2008, 36(4 Suppl): S146-51 AKl defined as RRt requirement

Incidence of AKI in general population Crit Care Med, 2008,36(4 Suppl):S146-51 AKI defined as RRT requirement