臨牀透析 Vol.35 No.6(1)


特集名 AKI診療のエビデンスと課題
題名 AKIの疾患概念と診断基準
発刊年月 2019年 06月
著者 堀野 太郎 高知大学医学部内分泌代謝・腎臓内科
著者 寺田 典生 高知大学医学部内分泌代謝・腎臓内科
【 要旨 】 急性腎障害（acute kidney injury；AKI）は，「腎機能の突然の低下」として定義された広範な臨床症候群である．過去には重症型の急性腎不全 （acute renal failure；ARF）が関心の中心であったが，近年，急性で比較的軽度で可逆性の腎機能低下が腎予後，生命予後に悪影響を生じさせることが認識されるようになった．ARFの統一された診断基準や臨床的定義はなかったため，今世紀に入りRIFLE（Risk・Injury・Failure・Loss・End-Stage Kidney Disease）基準，AKIN（Acute Kidney Injury Network）基準を経て，AKIの統一基準として2012年にKDIGO（ Kidney Disease：Improving Global Outcomes）基準が報告された．本稿では，KDIGO基準とAKI診断の注意点について概説する．
Theme Evidence and issue for clinical practice of acute kidney injury
Title Disease concept and diagnostic criteria of acute kidney injury
Author Taro Horino Department of Endocrinology, Metabolism and Nephrology, Kochi University School of Medicine
Author Yoshio Terada Department of Endocrinology, Metabolism and Nephrology, Kochi University School of Medicine
[ Summary ] Acute kidney injury (AKI) is a clinical syndrome that includes a broad spectrum of kidney injury and is defined as "a sudden loss of kidney function". Previously, acute renal failure (ARF), a severe form of acute renal dysfunction, received a great deal of attention from the medical fraternity. However, it has recently been recognized that even acute, relatively mild and reversible renal dysfunction adversely affects renal prognosis and overall life prognosis. No unified diagnostic criteria and/or clinical definitions are available for ARF. Therefore, the Risk, Injury, Failure, Loss, End-Stage Kidney Disease and the Acute Kidney Injury Network criteria were reported in 2004 and 2007, respectively. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were reported in 2012 as standardized criteria for AKI. We outline the KDIGO criteria and precautions associated with the diagnosis of AKI.
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