急性肾损伤指南解读课件

《急性肾损伤指南解读课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、KDIGO急性肾损伤指南解读KDIGOClinicalPracticeGuidelineforAcuteKidneyInjuryKidneyinter.Suppl.2012;2:1–138GRADE系统总推荐条目87条未分级26条29.9%2级39条63.9%1级22条36.1%1A:914.8%1B:1016.4%1C:34.9%2A:23.3%2B:1016.4%2C:2032.8%2D:711.5%内容IntroductionandMethodologyAKIDefinitionPreventionandTreatmentofA

2、KIContrast-inducedAKIDialysisInterventionsforTreatmentofAKIStageSerumcreatinineUrineoutput11.5–1.9timesbaselineOR<0.5ml/kg/hfor≥0.3mg/dl(≥26.5mmol/l)increase6–12hours22.0–2.9timesbaseline<0.5ml/kg/hfor≥12hours33.0timesbaselineORIncreaseinserumcreatinineto<0.3ml/kg/hfor≥

3、4.0mg/dl(≥353.6mmol/l)≥24hoursORORInitiationofrenalreplacementtherapyAnuriafor≥12hoursOR,Inpatients<18years,decreaseineGFRto<35ml/minper1.73m2AKI分级(NotGraded)ThecauseofAKIshouldbedeterminedwheneverpossible.(NotGraded)SelectedcausesofAKIrequiringimmediatediagnosisandspec

4、ifictherapiesRecommendeddiagnostictestsDecreasedkidneyperfusionVolumestatusandurinarydiagnosticindicesAcuteglomerulonephritis,vasculitis,Urinesedimentexamination,interstitialnephritis,thromboticserologictestingandMicroangiopathyhematologictestingUrinarytractobstructionK

5、idneyultrasoundWerecommendthatpatientsbestratifiedforriskofAKIaccordingtotheirsusceptibilitiesandexposures.(1B)ManagepatientsaccordingtotheirsusceptibilitiesandexposurestoreducetheriskofAKI.(NotGraded)TestpatientsatincreasedriskforAKIwithmeasurementsofSCrandurineoutputt

6、odetectAKI.(NotGraded)Individualizefrequencyanddurationofmonitoringbasedonpatientriskandclinicalcourse.(NotGraded)ExposuresSusceptibilitiesSepsisDehydrationorvolumedepletionCriticalillnessAdvancedageCirculatoryshockFemalegenderBurnsBlackraceTraumaCKDCardiacsurgery(espec

7、iallyChronicdiseases(heart,lung,liver)withCPB)MajornoncardiacsurgeryDiabetesmellitusNephrotoxicdrugsCancerRadiocontrastagentsAnemiaPoisonousplantsandanimalsCausesofAKI:exposuresandsusceptibilitiesfornon-specificAKIEvaluatepatientswithAKIpromptlytodeterminethecause,withs

8、pecialattentiontoreversiblecauses.(NotGraded)MonitorpatientswithAKIwithmeasurementsofSCrandurineoutputtostaget