急性肾损伤

新型治疗药物

对新型治疗药物的使用进行了研究，包括心房利钠肽、茶碱、胰岛素样生长因子、表皮生长因子、氧自由基清除剂、粘附分子抗体和前列腺素。没有一种药物被证明对治疗人类 AKI 有益。[18]Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005 Jan 29-Feb 4;365(9457):417-30. http://www.ncbi.nlm.nih.gov/pubmed/15680458?tool=bestpractice.com 关于他汀类药物是否具有保护作用（无论是干预前使用还是长期使用），仍然存在争议，[104]Pappy R, Stavrakis S, Hennebry TA, et al. Effect of statin therapy on contrast-induced nephropathy after coronary angiography: a meta-analysis. Int J Cardiol. 2011 Sep 15;151(3):348-53. http://www.ncbi.nlm.nih.gov/pubmed/21636154?tool=bestpractice.com [105]Zhang T, Shen LH, Hu LH, et al. Statins for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Am J Nephrol. 2011;33(4):344-51. https://www.karger.com/Article/FullText/326269 http://www.ncbi.nlm.nih.gov/pubmed/21430372?tool=bestpractice.com [106]Zhang BC, Li WM, Xu YW. High-dose statin pretreatment for the prevention of contrast-induced nephropathy: a meta-analysis. Can J Cardiol. 2011 Nov-Dec;27(6):851-8. http://www.ncbi.nlm.nih.gov/pubmed/21944277?tool=bestpractice.com [ ] Do statins help prevent acute kidney injury after surgical procedures requiring cardiac bypass?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.824/full展示答案 但近期相关研究的结果是令人失望的。[107]Giacoppo D, Capodanno D, Capranzano P, et al. Meta-analysis of randomized controlled trials of preprocedural statin administration for reducing contrast-induced acute kidney injury in patients undergoing coronary catheterization. Am J Cardiol. 2014 Aug 15;114(4):541-8. http://www.ncbi.nlm.nih.gov/pubmed/25001154?tool=bestpractice.com [108]Gandhi S, Mosleh W, Abdel-Qadir H, et al. Statins and contrast-induced acute kidney injury with coronary angiography. Am J Med. 2014 Oct;127(10):987-1000. http://www.ncbi.nlm.nih.gov/pubmed/24852935?tool=bestpractice.com [109]Bangalore S, Fayyad R, Hovingh GK, et al. Statin and the risk of renal-related serious adverse events: Analysis from the IDEAL, TNT, CARDS, ASPEN, SPARCL, and other placebo-controlled trials. Am J Cardiol. 2014 Jun 15;113(12):2018-20. http://www.ncbi.nlm.nih.gov/pubmed/24793673?tool=bestpractice.com 控制性降温和输注重组碱性磷酸酶可能会对患者有益。[110]Susantitaphong P, Alfayez M, Cohen-Bucay A, et al. Therapeutic hypothermia and prevention of acute kidney injury: a meta-analysis of randomized controlled trials. Resuscitation. 2012 Feb;83(2):159-67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273643 http://www.ncbi.nlm.nih.gov/pubmed/21983123?tool=bestpractice.com [111]Pickkers P, Heemskerk S, Schouten J, et al. Alkaline phosphatase for treatment of sepsis-induced acute kidney injury: a prospective randomized double-blind placebo-controlled trial. Crit Care. 2012 Jan 23;16(1):R14. https://ccforum.biomedcentral.com/articles/10.1186/cc11159 http://www.ncbi.nlm.nih.gov/pubmed/22269279?tool=bestpractice.com 促红细胞生成素没有表现出肾脏保护作用，[112]Kim JE, Song SW, Kim JY, et al. Effect of a single bolus of erythropoietin on renoprotection in patients undergoing thoracic aortic surgery with moderate hypothermic circulatory arrest. Ann Thorac Surg. 2016 Feb;101(2):690-6. http://www.ncbi.nlm.nih.gov/pubmed/26576750?tool=bestpractice.com 对于已确诊 AKI 的患者，相比其他治疗，使用甲状腺激素治疗的结局更差；其预防 AKI 的作用并未被充分证实。[113]Nigwekar SU, Strippoli GF, Navaneethan SD. Thyroid hormones for acute kidney injury. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD006740. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006740.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/23440810?tool=bestpractice.com 远期缺血性预处理似乎有望能够预防 AKI，但两项系统评价（包括超过 28 项随机对照临床试验）对该治疗的价值提出了质疑。[114]Yang Y, Lang XB, Zhang P, et al. Remote ischemic preconditioning for prevention of acute kidney injury: a meta-analysis of randomized controlled trials. Am J Kidney Dis. 2014 Oct;64(4):574-83. http://www.ncbi.nlm.nih.gov/pubmed/24954246?tool=bestpractice.com [115]Menting TP, Wever KE, Ozdemir-van Brunschot DMD, et al. Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury. Cochrane Database Sys Rev. 2017 Mar 4;(3):CD010777. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010777.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/28258686?tool=bestpractice.com [116]Moore PK, Hsu RK, Liu KD. Management of acute kidney injury: core curriculum 2018. Am J Kidney Dis. 2018 Feb 22;72(1):136-48. https://www.ajkd.org/article/S0272-6386(17)31141-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29478864?tool=bestpractice.com [ ] What are the benefits and harms of ischemic preconditioning for reducing renal ischemia reperfusion injury?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.1728/full展示答案