2012年 · 第51卷第12期

Acute kidney injury (AKI) manifests as an acute decline in renal function caused by various reasons, and is a clinically severe disease affecting multiple organs and systems. In recent years, it has been reported in the literature that mild to moderate renal function impairment can lead to serious clinical consequences, which further extends the focus of academic circles from Acute kidney failure (AKF) to broad injury. In March 2012, the Working Group on Improving the Overall Outcome of Kidney Disease (KDIGO) issued the KDIGO Clinical Practice Guidelines for Acute Kidney Injury (hereinafter referred to as the "Guidelines")^[1]The aim is to improve the practice level of medical workers' diagnosis and treatment of AKI. The guidelines put forward suggestions on diagnosis, prevention, drug treatment and renal replacement therapy (RRT) of AKI by using GRADE rating, which has positive guiding significance for clinical work. The author makes an interpretation report on the diagnosis and treatment principles, contrast nephropathy, RRT and other hot spots of the guideline.

Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid decline in GFR caused by a variety of etiologies and a common critical disease involving multiple disciplines^[1]。 At present, AKI refers to renal tubular necrosis, and its important clinical manifestations are related to volume overload, hyperkalemia, acidosis and other metabolic wastes and retention of bodily fluids. The incidence of AKI in ICU ranged from 30.0% to 67.2%^[2]The mortality rate of patients requiring renal replacement therapy due to AKI is as high as 62.8%^[3]。 About 40% of surviving AKI patients remain chronic lesions, and 10% to 20% require continuous dialysis treatment^[2,4,5]。 The existing treatment methods are mainly to support symptoms, so early detection, diagnosis and intervention are the keys to determine the long-term and short-term prognosis of AKI patients.

recombinant tissue plasminogen activator (rt-PA) is currently the most effective drug for the treatment of acute ischemic stroke (AIS). Intravenous rt-PA thrombolysis within the time window is the only treatment proven to reduce the disability rate of surviving patients with AIS. Since 2006, China's "Expert Consensus on Clinical Application of Recombinant Tissue Plasminogen Activator Intravenous Thrombolysis in the Treatment of Ischemic Stroke"^[1]Since its publication, AIS intravenous thrombolytic therapy has made great progress, so it is necessary to update the expert consensus.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are inflammatory diseases whose etiology has not been fully elucidated, and inflammatory factors such AS TNF α play a crucial role in their pathogenesis. At present, a variety of TNF α inhibitors have been marketed, mainly for the treatment of RA and AS. infliximab (trade name^®) is the earliest TNF α monoclonal antibody marketed in China, and it has been marketed abroad for more than ten years. A large amount of clinical evidence has provided valuable experience for its application in China. Based on the "Reference Opinions on Infliximab in the Treatment of Rheumatoid Arthritis and Ankylosing Spondylitis" formulated in 2009, combined with the new progress in the diagnosis and treatment of RA and AS at home and abroad in the past two years, and the updated suggestions of the American College of Rheumatology on RA treatment, domestic rheumatology experts have conducted serious discussions again on the clinical application, efficacy, monitoring and treatment of adverse reactions of infliximab in RA and AS, with reference to foreign experience, combined with China's national conditions and 5 years of clinical application experience, and updated reference opinions, which are summarized AS follows.