As incidências relatadas de lesão renal aguda (LRA) variam e são confusas devido a diferenças no diagnóstico, critérios de definição ou códigos de alta hospitalar.[6]Centers for Disease Control and Prevention (CDC). Hospitalization discharge diagnoses for kidney disease: United States, 1980-2005. MMWR Morb Mortal Wkly Rep. 2008 Mar 28;57(12):309-12.
http://www.ncbi.nlm.nih.gov/pubmed/18368005?tool=bestpractice.com
[7]Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007 Apr;18(4):1292-8.
https://jasn.asnjournals.org/content/18/4/1292.long
http://www.ncbi.nlm.nih.gov/pubmed/17314324?tool=bestpractice.com
Nos EUA, o número de hospitalizações em decorrência de LRA aumentou de 953,926 em 2000 para 3,959,560 em 2014.[8]Pavkov ME, Harding JL, Burrows NR. Trends in hospitalizations for acute kidney injury - United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2018 Mar 16;67(10):289-93.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6710a2.htm
http://www.ncbi.nlm.nih.gov/pubmed/29543788?tool=bestpractice.com
Dentre as pessoas hospitalizadas em 2014 com LRA, 40% também tinham diabetes.[8]Pavkov ME, Harding JL, Burrows NR. Trends in hospitalizations for acute kidney injury - United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2018 Mar 16;67(10):289-93.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6710a2.htm
http://www.ncbi.nlm.nih.gov/pubmed/29543788?tool=bestpractice.com
No Reino Unido, a incidência varia de 172 a até 630 por milhão da população (pmp) por ano, dependendo do estudo.[9]Lewington A, Kanagasundaram S. Renal Association clinical practice guidelines: acute kidney injury. Nephron Clin Pract. 2011;118 Suppl 1:c349-90.
https://www.karger.com/Article/Pdf/328075
http://www.ncbi.nlm.nih.gov/pubmed/21555903?tool=bestpractice.com
A incidência geral entre pacientes hospitalizados varia de 13% a 22%.[3]National Institute for Health and Care Excellence. Acute kidney injury: prevention, detection and management. Dec 2019 [internet publication].
https://www.nice.org.uk/guidance/ng148
[10]Wang HE, Muntner P, Chertow GM, et al. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35(4):349-55.
https://www.karger.com/Article/FullText/337487
http://www.ncbi.nlm.nih.gov/pubmed/22473149?tool=bestpractice.com
Na unidade de terapia intensiva (UTI), a incidência de LRA é mais alta.[11]Case J, Khan S, Khalid R, et al. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract. 2013;2013:479730.
https://www.hindawi.com/journals/ccrp/2013/479730
http://www.ncbi.nlm.nih.gov/pubmed/23573420?tool=bestpractice.com
Escores de predição foram desenvolvidos para desfechos de LRA, mas tiveram sucesso variado.[12]Ohnuma T, Uchino S, Toki N, et al. External validation for acute kidney injury severity scores: a multicenter retrospective study in 14 Japanese ICUs. Am J Nephrol. 2015;42(1):57-64.
http://www.ncbi.nlm.nih.gov/pubmed/26337793?tool=bestpractice.com
[13]Poukkanen M, Vaara ST, Reinikainen M, et al. Predicting one-year mortality of critically ill patients with early acute kidney injury: data from the prospective multicenter FINNAKI study. Crit Care. 2015 Mar 27;19:125.
https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-0848-2
http://www.ncbi.nlm.nih.gov/pubmed/25887685?tool=bestpractice.com
A necrose tubular aguda (NTA) é responsável por 45% dos casos de LRA. A NTA em pacientes na UTI é causada por sepse em 19% dos casos. Azotemia pré-renal, obstrução, glomerulonefrite, vasculite, nefrite intersticial aguda, doença renal crônica ou aguda e lesão ateroembólica são responsáveis pela maioria dos casos restantes.[14]Mehta R, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21.
http://www.ncbi.nlm.nih.gov/pubmed/15458458?tool=bestpractice.com
[15]Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996 Sep;50(3):811-8.
http://www.ncbi.nlm.nih.gov/pubmed/8872955?tool=bestpractice.com
A incidência da nefropatia por contraste varia e é relatada como sendo a terceira causa mais comum de LRA em pacientes hospitalizados. Em um estudo de 7500 pacientes submetidos à intervenção percutânea para doença arterial coronariana (DAC), 3.3% do total de pacientes apresentaram LRA, definida como um aumento na creatinina sérica de 38 micromoles/L (0.5 mg/dL) ou mais, e 25% dos pacientes com uma creatinina basal de pelo menos 153 micromoles/L (2.0 mg/dL) apresentaram LRA.[16]Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002 May 14;105(19):2259-64.
https://www.ahajournals.org/doi/full/10.1161/01.cir.0000016043.87291.33
http://www.ncbi.nlm.nih.gov/pubmed/12010907?tool=bestpractice.com
Até 7% dos casos de pacientes hospitalizados por LRA requerem terapia renal substitutiva.[17]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
Na UTI, a taxa de mortalidade excede 50% em casos de insuficiência de múltiplos órgãos que necessitam de diálise.[14]Mehta R, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21.
http://www.ncbi.nlm.nih.gov/pubmed/15458458?tool=bestpractice.com
[15]Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996 Sep;50(3):811-8.
http://www.ncbi.nlm.nih.gov/pubmed/8872955?tool=bestpractice.com
[17]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
Aumentos menores na creatinina (≥26.5 micromoles/L [0.3 mg/dL]) são associados a um aumento do risco de mortalidade hospitalar, doença renal crônica e riscos maiores de progressão para insuficiência renal em estágio terminal.