The pathophysiology of cardiac surgery-associated acute kidney injury (CSA-AKI)

摘要: Cardiac surgery associated acute kidney injury (CSA-AKI) is a significant clinical problem. Its pathogenesis complex and multifactorial. It likely involved at least six major pathways: exogenous endogenous toxins, metabolic factors, ischemia reperfusion, neurohormonal activation, inflammation oxidative stress. These mechanisms of are to be active different times with intensity probably act synergistically. Because such complexity the small number randomised controlled investigations in this field only limited recommendations can made. Nonetheless, it appears important avoid nephrotoxic drugs desirable hyperglycemia peri-operative period. The duration cardiopulmonary bypass should whenever possible. Off-pump surgery, when indicated, may decrease risk AKI. Invasive hemodynamic monitoring focussed on attention maintaining euvolemia, an adequate cardiac output arterial blood pressure desirable. Echocardiography useful minimizing atheroembolic complications. administration N-acetylcysteine protect from stress not recommended. There marked lack trials field.