摘要
急性肾损伤(acute kidney injury,AKI)对妊娠期妇女来说是一种严重并潜在致命的并发症。与在一般人群相同,妊娠期AKI可由导致肾衰竭的任何原因引起(如肾前性因素的肾灌注下降引起的急性肾小管坏死,肾性因素的急性肾小球肾炎、血管炎、急性间质性肾炎、血栓性微血管病,肾后性因素的尿路梗阻)。然而,导致妊娠期AKI的病因各有其特征。在妊娠早期,肾前性氮质血症最常见的原因是由于剧烈呕吐所致的肾前性疾病或源于败血症性流产的急性肾小管坏死;在妊娠中晚期,严重子痫前期,溶血、肝酶升高和血小板减少综合征(HELLP综合征),溶血尿毒综合征(HUS),血栓性血小板减少性紫癜(TTP)及妊娠期急性脂肪肝(AFLP)均可导致急性肾功能衰竭。另外,对妊娠前已存在肾脏病的孕妇,肾功能不全的程度是影响妊娠结局的主要因素。因此,充分认识导致妊娠期AKI的不同病因是做好妊娠期管理、预防妊娠期并发症和安全分娩的关键。
Acute kidney injury （AKI） is a severe and potentially fatal complication in pregnant women. Pregnant AKI can lead to renal failure （RF） caused by any reasons （such as acute tubular necrosis （ATN） by decreased renal perfusion due to prerenal factors, and acute glomerulonephritis, vasculitis, acute interstitial nephritides and thrombotic microangiopathy due to renal factors, and urinary obstruction due to postrenal factors]. However, the causes of pregnant AKI are of varying features. In early pregnancy, the most common problem of prerenal azotemia is prerenal diseases due to vomiting or ATN due to septicemia a- bortion; in middle and advanced stages, severe preeclampsia, increased hepatic enzymes and thrombocytopenia （HELLP syn- drome）, hemolytic uremic syndrome （HUS） , thrombotic thrombocytopenic purpura （TIP） and acute fatty liver of pregnancy （AFLP） can lead to acute RF. In addition, for those who have renal diseases before pregnancy, the degree of renal dysfunction is the main factor influencing pregnancy outcome. Therefore, full understanding of causes for pregnancy AKI is the key for proper clinical, management, complication prevention and safe delivery.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第2期229-232,共4页
Chinese General Practice
关键词
急性肾损伤
病因
妊娠
妊娠并发症
Acute kidney injury
Etiology
Pregnancy
Pregnancy complications
