最后审阅: 10 四月 2021
最后更新: 05 三月 2020

小结

定义

病史和体格检查

关键诊断因素

  • 低血压
  • 危险因素
  • 肾损伤
  • 尿量减少
  • 下尿路症状
  • 容量过负荷/肺水肿症状
  • 呕吐/恶心
  • 发热、皮疹和/或关节痛
  • 血尿(肉眼或镜下可见
  • 可触及膀胱和/或前列腺肿大和/或腹胀

其他诊断因素

  • 头晕和直立性症状
  • 高血压
  • 精神状态改变
  • 心包/胸膜摩擦音
  • 肌肉压痛
  • 咯血
  • 腹部血管杂音

危险因素

  • 高龄
  • 基础肾脏疾病
  • 糖尿病
  • 脓毒症
  • 碘化造影剂
  • 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
  • 过多体液流失
  • 手术
  • 出血
  • 近期的血管干预
  • 心搏骤停
  • 胰腺炎
  • 创伤
  • 恶性高血压
  • 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
  • 药物过量
  • 肾结石
  • 药物滥用
  • 酗酒
  • 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

诊断性检查

首要检查

  • 基础代谢(包括尿素和肌酐及肝功能检查
  • 血钾
  • 全血细胞计数 (FBC
  • 碳酸氢盐
  • C 反应蛋白
  • 血培养
  • 尿液分析
  • 尿液培养
  • 尿量监测
  • 液体冲击
  • 静脉血气分析
  • 胸部 X 线检查(CXR
  • 心电图(ECG

需考虑的检查

  • 肾尿路超声
  • 腹部 CT 或 MRI 扫描
  • 核素肾血流量扫描
  • 尿渗透压
  • 尿钠浓度
  • 钠/尿素排泄分数
  • 尿嗜酸性粒细胞计数
  • 血清肌酸激酶
  • ANA(抗核抗体
  • 抗双链 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 (ANCA)
  • 急性肝炎相关检查
  • HIV 血清学
  • 冷球蛋白
  • 抗溶血性链球菌 O 抗体
  • 血清/尿电泳
  • 膀胱镜检查
  • 肾脏活检

新兴检查

  • 新型血清和尿液生物标志物

治疗流程

急症处理

撰稿人

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

利益声明

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Richard A. Lafayette MD

Professor of Medicine

Nephrology Division

Stanford University Medical Center

Stanford

CA

利益声明

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.

同行评议者展开全部内容

Consultant Nephrologist

Newcastle upon Tyne Hospitals NHS Trust

Clinical Lead

Newcastle Hospitals Haemodialysis Service

Honorary Clinical Senior Lecturer

Newcastle University

Newcastle

UK

利益声明

SK was an expert adviser to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report into AKI and is lead author of the UK Renal Association clinical practice guideline on AKI.

Section Editor, BMJ Best Practice

Consultant in Paediatric Emergency Medicine

Royal London Hospital

London

UK

利益声明

TD declares that she has no competing interests.

Head of Editorial, BMJ Knowledge Centre

利益声明

JH declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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