Title: Management of AKI
题目：急性肾损伤的处理
Author 作者: Michael Winters

Managing Critically Ill Patients with AKI
治疗具有急性肾损伤的危重病人
Acute kidney injury (AKI) occurs in almost 50% of hospitalized patients and is an independent risk factor for mortality. 
50％的住院病人会出现急性肾损伤（AKI），是增加死亡率的独立危险因素。
Updated guidelines have recently been published on the management of patients with AKI.
有关AKI病人的处理已有新的指南发表（见参考文献）。
Pearls for the management of patients with, or at risk of, AKI include:
处理AKI病人的要点有：
Optimize volume status and perfusion pressure
改善容量水平和灌注压
Crystalloids preferred over colloids
晶体液优势于胶体液
Consider vasopressors to maintain MAP > 65 mm Hg
可考虑血管升压剂以维持平均动脉压大于65mmHg
Avoid nephrotoxic drugs
避免有肾毒性药物
Control co-factors
控制并发因素
Monitor intra-abdominal pressure
监测腹内压力
Avoid hyperglycemia - target glucose < 150 mg/dL
避免高血糖－目标血糖低于150mg／dl

References 参考文献

Brienza N, et al. Protocoled resuscitation and the prevention of acute kidney injury. Curr Opin Crit Care 2012; 18:613-622.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int 2012; 2(S):1-138.