Advances in Diagnosis and Management of Acute Kidney Injury Induced by Crush Syndrome

doi:10.12114/j.issn.1007-9572.2021.02.132

Abstract

Abstract:

Crush syndrome (CS) often occurs in victims of natural disasters, trauma and traffic accidents, which mainly manifests as hypovolemic shock, acute kidney injury (AKI) , hyperkalemia, and acidosis, among which AKI is a major cause of the continuing high mortality of CS. Current treatments for AKI induced by CS include early rehydration, symptomatic treatment and renal replacement therapy, but the effects are not satisfactory. There are no standard treatment options for CS-related AKI, so identifying the pathogenesis of this disease and formulating an effective treatment regimen may be problems need to be solved urgently. This article reviews the latest advances in pathogenesis and treatment strategies of CS-related AKI.

Key words: Crush syndrome, Acute kidney injury, Pathogenesis, Diagnosis, Research progress

摘要：

挤压综合征广泛存在于自然灾害、创伤及交通事故中，主要表现为低血容量休克、急性肾损伤、高钾血症、酸中毒等，其中急性肾损伤是挤压综合征患者病死率居高不下的重要因素之一。目前挤压综合征相关急性肾损伤的治疗包括早期补液、对症治疗及肾脏替代疗法等，然而效果并不理想。国内外针对挤压综合征相关急性肾损伤的治疗尚无标准方案，因此明确发病机制及制定有效治疗方案可能是未来亟待解决的问题。本文就挤压综合征相关急性肾损伤的发病机制及治疗策略进行综述。

关键词: 挤压综合征, 急性肾损伤, 发病机制, 诊断, 研究进展

Jinxiang WANG,Yuxin DONG,Yibo ZHAO, et al. Advances in Diagnosis and Management of Acute Kidney Injury Induced by Crush Syndrome[J]. Chinese General Practice, 2022, 25(15): 1914-1918. DOI: 10.12114/j.issn.1007-9572.2021.02.132.
王晋祥,董宇新,赵一博等. 挤压综合征相关急性肾损伤的诊疗进展[J]. 中国全科医学, 2022, 25(15): 1914-1918. DOI: 10.12114/j.issn.1007-9572.2021.02.132.

Figures/Tables 1

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肾功能分级	肾小球滤过率标准	尿量标准
危险	血肌酐上升1.5倍或肾小球滤过率下降25%~50%	尿量<0.5 ml·kg^-1 ·h^-1，持续6 h
损伤	血肌酐上升2倍或肾小球滤过率下降51%~75%	尿量<0.5 ml·kg^-1 ·h^-1，持续12 h
衰竭	血肌酐上升3倍或肾小球滤过率下降>75%或血肌酐≥4 mg/dl或血肌酐急剧上升≥0.5 mg/dl	尿量<0.3 ml·kg^-1 ·h^-1，持续24 h或无尿12 h
丧失	持续肾功能完全丧失>4周	-
终末期肾病	持续肾功能完全丧失>3个月	-

肾功能分级	肾小球滤过率标准	尿量标准
危险	血肌酐上升1.5倍或肾小球滤过率下降25%~50%	尿量<0.5 ml·kg^-1 ·h^-1，持续6 h
损伤	血肌酐上升2倍或肾小球滤过率下降51%~75%	尿量<0.5 ml·kg^-1 ·h^-1，持续12 h
衰竭	血肌酐上升3倍或肾小球滤过率下降>75%或血肌酐≥4 mg/dl或血肌酐急剧上升≥0.5 mg/dl	尿量<0.3 ml·kg^-1 ·h^-1，持续24 h或无尿12 h
丧失	持续肾功能完全丧失>4周	-
终末期肾病	持续肾功能完全丧失>3个月	-