小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 少尿或无尿
- 低血压
- 心动过速
其他诊断因素
- 经口进食不佳和厌食症
- 不适感
- 口渴
- 头晕
- 端坐呼吸/呼吸困难
- 水肿
危险因素
- 慢性肾脏病 (CKD)
- 慢性高血压
- 糖尿病
- 年龄较大
- 低灌注状态
- 脓毒症
- 大手术
- 肾毒性药物暴露
- 接触放射性造影剂
- 内源性毒素暴露
诊断性检查
首要检查
- 基础代谢（包括尿素和肌酐）
- 尿素/肌酐比
- 尿钠浓度
- 尿渗透压
- 尿钠排泄分数
- 尿素排泄分数
- 尿沉渣分析
- 全血细胞计数 (FBC)
- 凝血功能检查
- 尿肌红蛋白
需考虑的检查
- 动脉血气 (arterial blood gas, ABG)分析
- 血小板聚集试验
- 超声
- 心电图 (ECG)
- 超声测量下腔静脉（IVC）直径
- 肾脏活组织检查
- 血清和尿液生物学标志物
治疗流程
急性肾小管坏死 (ATN)
撰稿人
作者
Maria Jesus Lloret Cora, MD, MSc
Consulting Staff
Nephrology Department
Fundació Puigvert
Barcelona
Spain
利益声明
MJLC declares that she has no competing interests.
Leonor Fayos de Arizon, MD
Resident
Nephrology Department
Fundació Puigvert
Barcelona
Spain
利益声明
LFA declares that she has no competing interests.
鸣谢
Dr Maria Jesus Lloret Cora would like to gratefully acknowledge Dr Roser Torra, the previous contributor to this topic.
利益声明
RT declares that she has no competing interests.
同行评议者
Ajay Kumar, MD, FACP
Medical Director
Blood Management
Cleveland Clinic
Cleveland
OH
利益声明
AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from medscape.com for the education webcast of the same presentation.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
利益声明
IM declares that he has no competing interests.
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
利益声明
RT declares that he has no competing interests.
鉴别诊断
- 肾前性氮质血症
- 肾性氮质血症
更多 鉴别诊断指南
- KDIGO 急性肾损伤临床实践指南
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