Summary
Definition
History and exam
Key diagnostic factors
- 存在危险因素
- 尿量减少
- 呕吐
- 头晕
- 端坐呼吸
- 阵发性夜间呼吸困难
- 肺水肿
- 低血压
- 心动过速
- 体位性低血压
- 高血压
- 外周水肿
- 肌肉压痛
- 肢体缺血
- 癫痫发作
- 前列腺梗阻的症状
- 血尿
- 发热
- 皮疹
- 关节痛/关节炎
- 精神状态改变
- 尿毒症征象
Risk factors
- 年龄较大
- 基础肾脏疾病
- 恶性高血压
- 糖尿病
- 骨髓增殖性疾病，例如多发性骨髓瘤
- 结缔组织病
- 钠潴留状态（例如，充血性心力衰竭、肝硬化、肾病综合征）
- 放射性造影剂
- 暴露于肾毒性药物（例如，氨基糖苷类、万古霉素+哌拉西林-他唑巴坦、癌症治疗、非甾体抗炎药或 ACE 抑制剂）
- 创伤
- 出血
- 脓毒症
- 胰腺炎
- 药物过量
- 手术
- 心脏停搏
- 近期的血管干预
- 体液流失过多
- 肾结石
- 药物滥用
- 酒精滥用
- 过度运动
- 近期输血史
- 恶性肿瘤
- 遗传易感性
- 使用肾素-血管紧张素系统抑制剂
- 质子泵抑制剂
- 草药治疗
Diagnostic tests
1st tests to order
- 基础代谢（包括尿素和肌酐）
- 血清尿素氮/肌酐比值
- 尿液分析
- 尿液培养
- 全血细胞计数
- 尿钠排泄分数
- 尿素排泄分数
- 尿嗜酸性粒细胞计数
- 静脉血气分析
- 液体冲击
- 膀胱导尿术
- 尿渗透压
- 尿钠浓度
- 肾脏超声
- 胸部 X 线检查
- 心电图 (ECG)
Tests to consider
- 抗核抗体 (ANA)
- 抗 DNA 抗体
- 补体 (C3、C4、CH50)
- 抗肾小球基底膜抗体
- 抗中性粒细胞胞质抗体
- 急性肝炎相关检查
- HIV 血清学
- 冷球蛋白
- 红细胞沉降率
- 抗溶血性链球菌 O 抗体
- 腹部计算机体层成像或磁共振成像扫描
- 核素肾血流量扫描
- 膀胱镜检查
- 肾脏活检
Treatment algorithm
Contributors
Authors
Richard A. Lafayette, MD
Professor of Medicine
Nephrology Division
Stanford University Medical Center
Stanford
CA
Disclosures
RAL works as a consultant and researcher for Relypsa, Inc. Although unrelated to this topic area, RAL also works as a consultant for Fibrogen, Inc.; Mallinckrodt, Inc.; and Omeros, Inc.; and as a researcher for Genentech, Inc.; Mallinckrodt, Inc.; GlaxoSmithKline, Inc.; Rigel, Inc.; Aurinia, Inc.; and the NIH.
Acknowledgements
Dr Richard A. Lafayette would like to gratefully acknowledge Dr Sandra Sabatini, Dr Neil Kurtzman, and Dr Corey D. Ball, the previous contributors to this topic. SS, NK, and CDB declare that they have no competing interests.
Peer reviewers
Garabed Eknoyan, MD
Professor of Medicine
Section of Nephrology
Department of Medicine
Baylor College of Medicine
Houston
TX
Disclosures
GE declares that he has no competing interests.
Dominic de Takats, MA, MRCP
Consultant Nephrologist
Nephrology
North Staffs Royal Infirmary
University Hospital of North Staffordshire
Stoke-on-Trent
UK
Disclosures
DdT declares that he has no competing interests.
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