Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open heart surgery, and is associated with increased mortality and morbidity. In patients in intensive care units, CSA-AKI is the second most common type of AKI after septic AKI. In this Review, we explore the definition of CSA-AKI, discuss its epidemiology and identify its risk factors. We discuss current theories of the pathophysiology of CSA-AKI and describe its clinical course. Furthermore, we introduce diagnostic tools with particular reference to novel biomarkers of AKI and their potential utility; we analyse currently applied interventions aimed at attenuating AKI in patients undergoing cardiac surgery; and describe evidence from randomized controlled trials aimed at preventing or treating CSA-AKI. Finally, we explore issues in the use of renal replacement therapy, its timing, its intensity and its preferred modalities in patients with CSA-AKI, and we discuss the prognosis of CSA-AKI in terms of patient survival and kidney recovery.

中文翻译：

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心脏手术相关的急性肾损伤：危险因素，病理生理学和治疗

心脏手术相关的急性肾损伤（CSA-AKI）是接受心脏直视手术的成年患者中最常见的临床重要并发症，并与死亡率和发病率增加相关。在重症监护病房的患者中，CSA-AKI是继脓毒症AKI之后第二大最常见的AKI类型。在本综述中，我们探讨了CSA-AKI的定义，讨论了其流行病学并确定了其危险因素。我们讨论了CSA-AKI病理生理学的最新理论，并描述了其临床过程。此外，我们介绍了诊断工具，特别是针对AKI的新型生物标志物及其潜在效用的参考。我们分析了目前为减轻接受心脏手术的患者的AKI而采用的干预措施；并描述旨在预防或治疗CSA-AKI的随机对照试验的证据。