医学
急性肾损伤
围手术期
重症监护医学
肾脏替代疗法
肾脏疾病
生物标志物
临床试验
外科
内科学
生物化学
化学
作者
Sam D. Gumbert,Felix Kork,Maisie L. Jackson,Naveen Vanga,Semhar J. Ghebremichael,Christy Y. Wang,Holger K. Eltzschig
出处
期刊:Anesthesiology
[Ovid Technologies (Wolters Kluwer)]
日期:2020-01-01
卷期号:132 (1): 180-204
被引量:142
标识
DOI:10.1097/aln.0000000000002968
摘要
Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.
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