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Острое почечное повреждение: современный взгляд на проблему
Батюшин М.М., Руденко Л.И., Кастанаян А.А., Воробьев Б.И. Острое почечное повреждение: современный взгляд на проблему. Consilium Medicum. 2016; 18 (7): 43–48. DOI: 10.26442/2075-1753_2016.7.43-48
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Batiushin M.M., Rudenko L.I., Kastanayan A.A., Vorobiev B.I. Acute kidney injury: a modern view on the problem. Consilium Medicum. 2016; 18 (7): 43–48. DOI: 10.26442/2075-1753_2016.7.43-48
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Аннотация
Острое повреждение почек (ОПП) – термин, пришедший взамен понятию «острая почечная недостаточность». ОПП представляет собой синдром резкого снижения функции почек, который характеризуется снижением диуреза вплоть до анурии, накоплением продуктов азотистого обмена и нарушением водно-электролитного обмена, а также ассоциируется с высокой летальностью и последующим развитием хронической почечной недостаточности. Диагностическими критериями ОПП являются показатели креатинина в сыворотке крови, величина скорости клубочковой фильтрации и объем диуреза. В основе развития ОПП лежат следующие группы причин: преренальные, ренальные и постренальные. Тактика терапии ОПП, в свою очередь, должна быть выбрана с учетом основного заболевания и степени тяжести ОПП. Для оценки эффективности терапии ОПП необходимо постоянно контролировать диурез, креатинин, мочевину и электролиты.
Ключевые слова: острое почечное повреждение, объем циркулирующей плазмы, хроническая болезнь почек.
Ключевые слова: острое почечное повреждение, объем циркулирующей плазмы, хроническая болезнь почек.
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Acute kidney injury (AKI) is the term that has come to replace the concept of «acute renal failure», it is a syndrome of sharp decline in renal function, which is characterized by decreased urine output up to anuria, accumulation products of nitrogen metabolism, and the violation of water-electrolyte metabolism, and is associated with high mortality and the subsequent development of chronic renal failure. Diagnostic criteria of AKI are serum creatinine, glomerular filtration rate and the magnitude of the volume of urine output. At the base of AKI are the following groups of reasons: prerenal, renal and postrenal. The therapyshould be selected taking into account the underlying disease and the degree of severity of the AKI. To evaluate the effectiveness of AKItherapy it must be constantly monitor diuresis, creatinine, urea and electrolytes.
Key words: acute kidney damage, the amount of circulating plasma, chronic kidney disease.
Key words: acute kidney damage, the amount of circulating plasma, chronic kidney disease.
Полный текст
Список литературы
1. Bellomo R, Cass A, Cole L et al. Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med 2009; 361: 1627–38.
2. Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20 (3): 672–9.
3. Piccinni P, Cruz DN, Gramaticopolo S et al. NEFROINT investigators. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol 2011; 77: 1072–83.
4. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012; 81 (5): 442–8.
5. Bouman C, Kellum JA, Lamiere N, Levin N. Definition of acute renal failure. Acute Dialysis Quality Initiative. 2nd International Consensus Conference, 2002; National Kidney Foundation KD: Clinical practice guidelines for chronic Kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (Suppl. 1): S1-S266.
6. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): R31.
7. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int (Suppl.) 2012; Issue 1: 1–126.
8. Zeng X, McMahon GM, Brunelli SM et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014; 9 (1): 12–20.
9. Батюшин М.М., Мационис А.Э., Повилайтите П.Е. и др. Клинико-морфологический анализ лекарственных поражений почек при терапии нестероидными противовоспалительными препаратами. Нефрология и диализ. 2009; 11 (1): 44–8. / Batiushin M.M., Matsionis A.E., Povilaitite P.E. i dr. Kliniko-morfologicheskii analiz lekarstvennykh porazhenii pochek pri terapii nesteroidnymi protivovospalitel'nymi preparatami. Nefrologiia i dializ. 2009; 11 (1): 44–8. [in Russian]
10. Смирнов А.В., Каюков И.Г., Дегтерева О.А. и др. Проблемы диагностики и стратификации тяжести острого повреждения почек. Нефрология. 2009; 13 (3): 9–18. / Smirnov A.V., Kaiukov I.G., Degtereva O.A. i dr. Problemy diagnostiki i stratifikatsii tiazhesti ostrogo povrezhdeniia pochek. Nefrologiia. 2009; 13 (3): 9–18. [in Russian]
11. Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med 2005; 142: 510–24.
12. Bonventre JV, Vaidya VS, Schmouder R et al. Next-generation biomarkers for detecting kidney toxicity. Nat Biotechnol 2010; 28 (5): 436–40.
13. Hsu CY, McCulloch CE, Fan D et al. Community-based incidence of acute renal failure. Kidney Int 2007; 72: 208–12.
14. Ostermann M, Chang RWS. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007; 35 (8): 1837–43.
15. Panichi V, Pasquariello A, Innocenti M et al. The Pisa experience of renal biopsies, 1977–2005. J Nephrol 2007; 20 (3): 329–35.
16. Батюшин М.М., Врублевская Н.С. Клинические проявления поражения почек при хронической сердечной недостаточности. Нефрология. 2010; 14 (4): 27–30. / Batiushin M.M., Vrublevskaia N.S. Klinicheskie proiavleniia porazheniia pochek pri khronicheskoi serdechnoi nedostatochnosti. Nefrologiia. 2010; 14 (4): 27–30. [in Russian]
17. Zappitelli M. Epidemiology and diagnosis of acute kidney injury. Semin Nephrol 2008; 28 (5): 436–46.
18. Cogliati AA, Vellutini R, Nardini A et al. Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study. J Cardiothorac Vasc Anesth 2007; 21: 847–85.
19. Conti M, Moutereau S, Zater M et al. Urinary cystatin C as a specifi c marker of tubular dysfunction. Clin Chem Lab Med 2006; 44 (3): 288–91.
20. Каюков И.Г., Румянцев А.Ш. Контраст-индуцированное ОПП. В кн.: Смирнов А.В., Добронравов В.А., Румянцев А.Ш. Острое повреждение почек. М.: МИА, 2015; с. 30–79. / Kaiukov I.G., Rumiantsev A.Sh. Kontrast-indutsirovannoe OPP. V kn.: Smirnov A.V., Dobronravov V.A., Rumiantsev A.Sh. Ostroe povrezhdenie pochek. M.: MIA, 2015; s. 30–79. [in Russian]
21. Kivikko M, Antila S, Eha J et al. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther 2002; 40: 465–71.
22. Добронравов В.А., Румянцев А.Ш. Острое повреждение почек. М.: МИА, 2015; с. 30–79. / Dobronravov V.A., Rumiantsev A.Sh. Ostroe povrezhdenie pochek. M.: MIA, 2015; s. 30–79. [in Russian]
23. Fouque D, Kalantar-Zadeh K, Kopple J et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73 (4): 391–8.
24. Murugan R, Kellum JA. Acute kidney injury: what's the prognosis? Nat Rev Nephrol 2011; 7: 209–17.
25. Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10 (3): R73.
26. Thakar CV, Christianson A, Almenoff P et al. Degree of acute kidney injury before dialysis initiation and hospital mortality in critically ill patients. Int J Nephrol 2013; 2013: 827459.
2. Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20 (3): 672–9.
3. Piccinni P, Cruz DN, Gramaticopolo S et al. NEFROINT investigators. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol 2011; 77: 1072–83.
4. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012; 81 (5): 442–8.
5. Bouman C, Kellum JA, Lamiere N, Levin N. Definition of acute renal failure. Acute Dialysis Quality Initiative. 2nd International Consensus Conference, 2002; National Kidney Foundation KD: Clinical practice guidelines for chronic Kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (Suppl. 1): S1-S266.
6. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): R31.
7. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int (Suppl.) 2012; Issue 1: 1–126.
8. Zeng X, McMahon GM, Brunelli SM et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014; 9 (1): 12–20.
9. Батюшин М.М., Мационис А.Э., Повилайтите П.Е. и др. Клинико-морфологический анализ лекарственных поражений почек при терапии нестероидными противовоспалительными препаратами. Нефрология и диализ. 2009; 11 (1): 44–8. / Batiushin M.M., Matsionis A.E., Povilaitite P.E. i dr. Kliniko-morfologicheskii analiz lekarstvennykh porazhenii pochek pri terapii nesteroidnymi protivovospalitel'nymi preparatami. Nefrologiia i dializ. 2009; 11 (1): 44–8. [in Russian]
10. Смирнов А.В., Каюков И.Г., Дегтерева О.А. и др. Проблемы диагностики и стратификации тяжести острого повреждения почек. Нефрология. 2009; 13 (3): 9–18. / Smirnov A.V., Kaiukov I.G., Degtereva O.A. i dr. Problemy diagnostiki i stratifikatsii tiazhesti ostrogo povrezhdeniia pochek. Nefrologiia. 2009; 13 (3): 9–18. [in Russian]
11. Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med 2005; 142: 510–24.
12. Bonventre JV, Vaidya VS, Schmouder R et al. Next-generation biomarkers for detecting kidney toxicity. Nat Biotechnol 2010; 28 (5): 436–40.
13. Hsu CY, McCulloch CE, Fan D et al. Community-based incidence of acute renal failure. Kidney Int 2007; 72: 208–12.
14. Ostermann M, Chang RWS. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007; 35 (8): 1837–43.
15. Panichi V, Pasquariello A, Innocenti M et al. The Pisa experience of renal biopsies, 1977–2005. J Nephrol 2007; 20 (3): 329–35.
16. Батюшин М.М., Врублевская Н.С. Клинические проявления поражения почек при хронической сердечной недостаточности. Нефрология. 2010; 14 (4): 27–30. / Batiushin M.M., Vrublevskaia N.S. Klinicheskie proiavleniia porazheniia pochek pri khronicheskoi serdechnoi nedostatochnosti. Nefrologiia. 2010; 14 (4): 27–30. [in Russian]
17. Zappitelli M. Epidemiology and diagnosis of acute kidney injury. Semin Nephrol 2008; 28 (5): 436–46.
18. Cogliati AA, Vellutini R, Nardini A et al. Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study. J Cardiothorac Vasc Anesth 2007; 21: 847–85.
19. Conti M, Moutereau S, Zater M et al. Urinary cystatin C as a specifi c marker of tubular dysfunction. Clin Chem Lab Med 2006; 44 (3): 288–91.
20. Каюков И.Г., Румянцев А.Ш. Контраст-индуцированное ОПП. В кн.: Смирнов А.В., Добронравов В.А., Румянцев А.Ш. Острое повреждение почек. М.: МИА, 2015; с. 30–79. / Kaiukov I.G., Rumiantsev A.Sh. Kontrast-indutsirovannoe OPP. V kn.: Smirnov A.V., Dobronravov V.A., Rumiantsev A.Sh. Ostroe povrezhdenie pochek. M.: MIA, 2015; s. 30–79. [in Russian]
21. Kivikko M, Antila S, Eha J et al. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther 2002; 40: 465–71.
22. Добронравов В.А., Румянцев А.Ш. Острое повреждение почек. М.: МИА, 2015; с. 30–79. / Dobronravov V.A., Rumiantsev A.Sh. Ostroe povrezhdenie pochek. M.: MIA, 2015; s. 30–79. [in Russian]
23. Fouque D, Kalantar-Zadeh K, Kopple J et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73 (4): 391–8.
24. Murugan R, Kellum JA. Acute kidney injury: what's the prognosis? Nat Rev Nephrol 2011; 7: 209–17.
25. Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10 (3): R73.
26. Thakar CV, Christianson A, Almenoff P et al. Degree of acute kidney injury before dialysis initiation and hospital mortality in critically ill patients. Int J Nephrol 2013; 2013: 827459.
________________________________________________
1. Bellomo R, Cass A, Cole L et al. Intensity of continuous renal replacement therapy in critically ill patients. N Engl J Med 2009; 361: 1627–38.
2. Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20 (3): 672–9.
3. Piccinni P, Cruz DN, Gramaticopolo S et al. NEFROINT investigators. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol 2011; 77: 1072–83.
4. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012; 81 (5): 442–8.
5. Bouman C, Kellum JA, Lamiere N, Levin N. Definition of acute renal failure. Acute Dialysis Quality Initiative. 2nd International Consensus Conference, 2002; National Kidney Foundation KD: Clinical practice guidelines for chronic Kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002; 39 (Suppl. 1): S1-S266.
6. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): R31.
7. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int (Suppl.) 2012; Issue 1: 1–126.
8. Zeng X, McMahon GM, Brunelli SM et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014; 9 (1): 12–20.
9. Batiushin M.M., Matsionis A.E., Povilaitite P.E. i dr. Kliniko-morfologicheskii analiz lekarstvennykh porazhenii pochek pri terapii nesteroidnymi protivovospalitel'nymi preparatami. Nefrologiia i dializ. 2009; 11 (1): 44–8. [in Russian]
10. Smirnov A.V., Kaiukov I.G., Degtereva O.A. i dr. Problemy diagnostiki i stratifikatsii tiazhesti ostrogo povrezhdeniia pochek. Nefrologiia. 2009; 13 (3): 9–18. [in Russian]
11. Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med 2005; 142: 510–24.
12. Bonventre JV, Vaidya VS, Schmouder R et al. Next-generation biomarkers for detecting kidney toxicity. Nat Biotechnol 2010; 28 (5): 436–40.
13. Hsu CY, McCulloch CE, Fan D et al. Community-based incidence of acute renal failure. Kidney Int 2007; 72: 208–12.
14. Ostermann M, Chang RWS. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007; 35 (8): 1837–43.
15. Panichi V, Pasquariello A, Innocenti M et al. The Pisa experience of renal biopsies, 1977–2005. J Nephrol 2007; 20 (3): 329–35.
16. Batiushin M.M., Vrublevskaia N.S. Klinicheskie proiavleniia porazheniia pochek pri khronicheskoi serdechnoi nedostatochnosti. Nefrologiia. 2010; 14 (4): 27–30. [in Russian]
17. Zappitelli M. Epidemiology and diagnosis of acute kidney injury. Semin Nephrol 2008; 28 (5): 436–46.
18. Cogliati AA, Vellutini R, Nardini A et al. Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study. J Cardiothorac Vasc Anesth 2007; 21: 847–85.
19. Conti M, Moutereau S, Zater M et al. Urinary cystatin C as a specifi c marker of tubular dysfunction. Clin Chem Lab Med 2006; 44 (3): 288–91.
20. Kaiukov I.G., Rumiantsev A.Sh. Kontrast-indutsirovannoe OPP. V kn.: Smirnov A.V., Dobronravov V.A., Rumiantsev A.Sh. Ostroe povrezhdenie pochek. M.: MIA, 2015; s. 30–79. [in Russian]
21. Kivikko M, Antila S, Eha J et al. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther 2002; 40: 465–71.
22. Dobronravov V.A., Rumiantsev A.Sh. Ostroe povrezhdenie pochek. M.: MIA, 2015; s. 30–79. [in Russian]
23. Fouque D, Kalantar-Zadeh K, Kopple J et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73 (4): 391–8.
24. Murugan R, Kellum JA. Acute kidney injury: what's the prognosis? Nat Rev Nephrol 2011; 7: 209–17.
25. Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10 (3): R73.
26. Thakar CV, Christianson A, Almenoff P et al. Degree of acute kidney injury before dialysis initiation and hospital mortality in critically ill patients. Int J Nephrol 2013; 2013: 827459.
Авторы
М.М.Батюшин, Л.И.Руденко*, А.А.Кастанаян, Б.И.Воробьев
ГБОУ ВПО Ростовский государственный медицинский университет Минздрава России. 344022, Россия, Ростов-на-Дону, Нахичеванский пер., д. 29
*rudenko.liliya@mail.ru
ГБОУ ВПО Ростовский государственный медицинский университет Минздрава России. 344022, Россия, Ростов-на-Дону, Нахичеванский пер., д. 29
*rudenko.liliya@mail.ru
________________________________________________
M.M.Batiushin, L.I.Rudenko*, A.A.Kastanayan, B.I.Vorobiev
Rostov State Medical University. 344022, Russian Federation, Rostov-on-Don, per. Nakhichevanskii, d. 29
*rudenko.liliya@mail.ru
Rostov State Medical University. 344022, Russian Federation, Rostov-on-Don, per. Nakhichevanskii, d. 29
*rudenko.liliya@mail.ru
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