【摘要】 急性肾损伤（acute kidney injury,AKI）是全球范围内的公共卫生疾病。根据全球性的前瞻性观察，成人和儿童AKI的发生率分别为39%和53%。一些新分类的可调控性肾小管细胞坏死是重症AKI的重要机制，包括凋亡样坏死、铁死亡、焦亡等。重度损伤后细胞周期阻滞、线粒体损伤、Wnt和P53等信号异常，微循环障碍及缺氧，免疫细胞极化及肾小管上皮转分化，可引起肾小管上皮失代偿性修复，最终导致AKI慢性化转化。尽管欧美国家认证了一批AKI早期诊断和远期预后的标志物，但这些标志物距临床应用还有距离。多标志物或芯片是标志物研发的另外一个方向，但受成本限制。利用电子医疗数据是加强AKI管理的另一策略，可构建电子预警系统。集束化管理工具可能成为未来强化AKI综合管理的重要手段。重症AKI启动肾脏替代治疗（kidney replacement therapy,KRT）的时机和剂量目前还缺乏共识。目前没有证据支持早期、大剂量连续性(连续替代治疗剂量>20 mL·kg^-1·h^-1)或更频繁的间歇性KRT（每周3次以上）方案有临床获益。AKI也是新型冠状病毒肺炎感染患者的常见并发症，病理表现为局灶性节段性硬化和急性肾小管坏死。AKI导致病死率上升，一旦发生需给予足够的支持治疗。更多还原

【Abstract】 Acute kidney injury(AKI) is a public health disease worldwide. According to global prospective observations, the incidence of AKI in adults and children was 39% and 53%, respectively.Some newly classified regulated tubular cell necrosis are essential mechanism in severe AKI, including necroptosis, ferroptosis and pyroptosis. After severe injury, cell cycle arrest, mitochondrial damage, Wnt and P53 signal abnormalities, microcirculation disturbance, hypoxia, immune cell polarization and renal tubular epithelial transdifferentiation can cause decompensated repair of renal tubular epithelium.These pathological repairs result in chronicity of AKI. Although a batch of AKI markers for early diagno?sis and long-term prognosis have been certified in European and American countries, these markers are still far from clinical application. Multiple markers or microarrays is alternative direction, in spit of cost limitation. Utilization of electronic medical data is another strategy to enhance AKI management. Based on it, electronic alert system and cluster management platform can be conducted, which will facilitate the comprehensive management of AKI in the future. Initiation timing and dosing of kidney replacement therapy( KRT) in serve AKI has not reached consensus. No evidence supports that early, high-dose con?tinuous replacement therapy(dose>20 mL·kg-1·h-1) or frequent intermittent KRT(more than 3 times per week) benefits clinically. AKI is also a common complication in patients with COVID-19 infection. The pathological changes are focal segmental sclerosis and acute tubular necrosis. AKI increases mortal?ity and requires adequate supportive care if it occurs.更多还原