急性腎損傷與重症透析之最新進展

Recent Update on Acute Kidney Injury and Critical Dialysis

郭錦輯(Chin-Chi Kuo) ； 周鈺翔(Yu-Hsiang Chou) ； 李柏葒(Po-Hung Lee) ； 陳昶旭(Chang-Hsu Chen) ； 王介立(Chieh-Li Wang) ； 蔡壁如(Pi-Ru Tsai) ； 吳允升(Vin-Cent Wu) ； 林水龍(Shuei-Liong Lin) ； 陳永銘(Yung-Ming Chen) ； 吳寬墩(Kwan-Dun Wu) ； 蔡敦仁(Tun-Jun Tsai) ； 柯文哲(Wen-Je Ko) ； 吳明修(Ming-Shiou Wu)

《內科學誌》 20卷4期 (2009/08) Pp. 320-334

https://doi.org/10.6314/JIMT.2009.20(4).06

摘要

近十年來，儘管醫療水準大幅提昇，然而急性腎衰竭患者的死亡率仍居高不下，尤其在重症患者合併急性腎衰竭之死亡率更高達百分之五、六十。在2002年，急性透析品質創始小組(Acute Dialysis Quality Initiative Group, ADQI)這個由腎臟科與急重症醫師所組成的團體提出一個新的診斷標準，就是RIFLE criteria並以急性腎損傷一詞(acute kidney injury)取代所謂的急性腎衰竭(acute renal failure)。於2005年，急性腎損傷照護網(Acute Kidney Injury Network，AKIN)進一步修訂RIFLE criteria。RIFLE和AKIN診斷標準更明確將急性腎損傷分期，提供了診斷分類的統一平台。以傳統的血清肌酸酐(serum creatinine)常常不能早期診斷急性腎損傷。目前已有一些生物標記如：NGAL、IL-18、KIM-1及cystatin C被認為能應用於早期診斷急性腎損傷。急性腎損傷如果能及早診斷，更早介入治療可爭取更長的有效治療時間，避免其衍生之合併症，並且能增加腎臟功能恢復的機會，最後改善病人的存活率。本文回顧近年文獻關於急性腎損傷定義的延革，病理生理的機轉，能早期反映急性腎損傷的生物標記，以及藥物治療與重症腎臟替代療法的新進展。

關鍵字

急性腎損傷 ； 急性腎損傷照護網 ； 嗜中性白血球明膠相關性脂質運載蛋白 ； 腎損傷分子 ； 連續性腎臟替代療法 ； 延長式間歇性腎臟替代療法

並列摘要

The definition of acute renal failure has not been unified during past five decades. Most clinicians used to define acute renal failure simply by the increase of serum creatinine arbitrarily. Without consistent criteria of acute renal failure, it has become a major barrier to integrate the clinical studies and daily clinical practice. In 2002, to resolve this issue, Acute Dialysis Quality Initiative Group (ADOQI) suggested new diagnostic criteria, RIFLE criteria, for acute renal failure, which was nominated as acute kidney injury (AKI) later. This standardized diagnostic criterion not only provides a platform helping integrate clinical information about AKI but also promote the understanding of its epidemiology. In addition, with the advances of molecular medicine, different perspectives of pathophysiology in AKI can be reached deeply and are also cornerstones of many current developing therapeutic strategies and diagnostic biomarkers including NGAL, IL-18, KIM-1, and Cystatin-C. Early diagnosis of AKI would help primary clinicians prevent its further deterioration and related complications, and augment the chance of renal recovery. Conventional therapies for AKI including volume expansion, renal perfusion maintenance, nephrotoxicity avoidance, and renal replacement therapy (RRT) are still lack of consensus in detail. However, through large clinical trials and meticulous data analysis, both has greatly enhanced the strength of clinical evidence from which more practical recommendations could be extracted.

並列關鍵字

Acute kidney injury ； Acute kidney injury network, AKIN ； Neutrophil gelatinase-associated lipocalin, NGAL ； Kidney injury molecule-1, KIM-1 ； Continuous renal replacement therapy, CRRT ； Prolonged intermittent