333 Ch 332. Acute Kidney Injury (AKI) — Diagnosis and Biomarkers

AKI = 短期內 (hours-days) 腎功能急速下降；KDIGO 2012 criteria：(1) Cr ↑ ≥ 0.3 mg/dL within 48 h，或 (2) Cr ↑ ≥ 1.5× baseline within 7 days，或 (3) UO < 0.5 mL/kg/h × 6 h；KDIGO staging 1-3：stage 1 (mild) Cr ↑ 0.3 mg or 1.5-1.9× baseline；stage 2 (moderate) 2-2.9×；stage 3 (severe) ≥ 3× or Cr ≥ 4 mg/dL or RRT；etiology 三大類：(1) pre-renal (hypovolemia, low CO, NSAID, ACE) — FENa < 1%, BUN/Cr > 20；(2) intrinsic (ATN ischemic/toxic, AIN, GN, vasculitis) — FENa > 2%, muddy brown casts；(3) post-renal (obstruction) — hydronephrosis on US；biomarkers 新興：NGAL, KIM-1, IGFBP7×TIMP-2 (Nephrocheck), L-FABP, cystatin C — 早期 detection；community-acquired AKI (CA-AKI): 多 pre-renal；hospital-acquired AKI (HA-AKI): ATN, sepsis, contrast, surgery；2024 emerging：urinary biomarkers + AI risk prediction + new staging proposals。