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Á¦¸ñ ±¹¿Ü ¿¬±¸µ¿Çâ NICE Guideline: ±Þ¼º ½Å¼Õ»ó(Acute kidney injury)
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±¹¿Ü ¿¬±¸µ¿Çâ NICE (National Institute for Health and Care Excellence)  Guideline: ±Þ¼º ½Å¼Õ»ó(Acute kidney injury: prevention, and detection 

[NICE guideline [NG148] Published date: December 2019]

 

1.1  ±Þ¼º ½Å¼Õ»ó »çÁ¤(Assessing risk of acute kidney injury)

 

±Þ¼º ÁúȯÀÌÀÖ´Â »ç¶÷ÀÇ ±Þ¼º ½Å¼Õ»ó È®ÀÎ

 

1.1.1 ±Þ¼º ÁúȯÀÌÀÖ´Â ¼ºÀÎÀÇ °æ¿ì ´ÙÀ½ Áß Çϳª¶óµµ Á¸ÀçÇÏ´Â °æ¿ì Ç÷û Å©·¹¾ÆƼ´ÑÀ» ÃøÁ¤ÇÏ°í ±âÁؼ±°ú ºñ±³ÇÏ¿© ±Þ¼º ½ÅÀå ¼Õ»óÀ» °Ë»çÇϱâ

 

-¸¸¼º½ÅÀåÁúȯ(¼ºÀÎÀÇ ÃßÁ¤ »ç±¸Ã¼ ¿©°úÀ² glomerular filtration rate [eGFR] 60 ml/min/1.73 m2 ¹Ì¸¸ÀÎ °æ¿ì, ƯÈ÷ À§Çè ÇÔ)

 

-½ÉÀå ¸¶ºñ

 

-°£ Áúȯ

 

-´ç´¢º´

 

-±Þ¼º ½ÅÀå ¼Õ»óÀÇ º´·Â

 

-ÇÌ´¢(oliguria, ¼Òº¯·® 0.5ml ¹Ì¸¸/ kg / ½Ã°£´ç)

 

-½Å°æ°è ¶Ç´ÂÀÎÁö Àå¾Ö ¶Ç´Â Àå¾Ö, °£º´Àο¡ ´ëÇÑ ÀÇÁ¸À¸·Î ÀÎÇØ Ã¼¾×¿¡ ´ëÇÑ Á¢±ÙÀÌ Á¦ÇÑ µÉ ¼ö ÀÖÀ½

 

-Hypovolemia

 

-Áö³­ 1 ÁÖ µ¿¾È ½ÅÀå ¼Õ»ó (¿¹ : ºñ ½ºÅ×·ÎÀ̵强 Ç׿°ÁõÁ¦ [NSAID], ¾Æ¹Ì³ë ±Û¸®Äڽõå(aminoglycosides), ¾ÈÁö¿ÀÅٽŠÀüȯ È¿¼Ò [ACE] ¾ïÁ¦Á¦(angiotensin?converting enzyme [ACE] inhibitors), ¾ÈÁö¿ÀÅٽŠII ¼ö¿ëü ±æÇ×Á¦ [ARB] ¹× ÀÌ´¢Á¦, angiotensin II receptor antagonists [ARBs] and diuretics))À» À¯¹ßÇϰųª ¾ÇÈ­½Ãų ¼öÀÖ´Â ¾à¹°ÀÇ »ç¿ë, ƯÈ÷ hypovolaemic °æ¿ì

 

-Áö³­ ÁÖ¿¡ ¿ä¿Àµå ±â¹Ý Á¶¿µÁ¦ »ç¿ë

 

-ºñ´¢±â°úÀû Àå¾ÖÀÇ Áõ»ó, ¶Ç´Â º´·Â, ȤÀº Æó¼â·Î À̾îÁú ¼öÀÖ´Â »óÅÂ

 

-ÆÐÇ÷Áõ

 

-Á¶±â °æ°í Á¡¼öÀÇ ¾ÇÈ­(deteriorating early warning scores)

 

-65¼¼ ÀÌ»ó




 

1.2 ±Þ¼º ½Å¼Õ»ó ¿¹¹æ(Preventing acute kidney injury)

Ongoing assessment of the condition of people in hospital

 

ÀÓ»ó »óÅ°¡ ¾ÇÈ­µÇ°Å³ª ¾ÇÈ­ µÉ À§ÇèÀÌÀÖ´Â ±Þ¼º ½Å¼Õ»óÀÇ À§ÇèÀÌÀÖ´Â ¼ºÀÎÀ» ½Äº°Çϱâ À§ÇØ Æ®·¢ ¹× Æ®¸®°Å ½Ã½ºÅÛ (Ãʱ⠰æ°í Á¡¼ö)À» »ç¿ëÇÏ´Â º´¿øÀÇ ±Þ¼º ȯÀÚ¿¡ ´ëÇÑ NICE ÁöħÀÇ ±ÇÀå »çÇ×À» µû¸£µµ·Ï ÇÑ´Ù.


 

1.2.2 ¼ºÀÎÀÌ ±Þ¼º ½ÅÀå ¼Õ»óÀÇ À§ÇèÀÌÀÖ´Â °æ¿ì, ÃßÀû ¹× Æ®¸®°Å ½Ã½ºÅÛ (Ãʱ⠰æ°í Á¡¼ö)ÀÌ ¼Òº¯¹èÃâ·®À» ¸ð´ÏÅ͵ÇÁö ¾ÊÀ¸¸é,  ½Ã½ºÅÛÀÌ ÇÌ´¢(oliguria) (¼Òº¯ ¹èÃâ·® 0.5 ml ¹Ì¸¸ / kg / ½Ã°£´ç)À» ÀνÄÇÏ°í ÀÌ¿¡ ´ëÀÀÇÒ ¼öÀÖ´Â ½Ã½ºÅÛÀ» °®Ãß¾î¾ßÇÕ´Ï´Ù.

 

1.2.3  ÀÓ»ó »óÅ°¡ ¾ÇÈ­µÇ°Å³ª ¾ÇÈ­ µÉ ¼ö ÀÖ´Â ±Þ¼º ½ÅÀå ¼Õ»óÀÇ À§ÇèÀÌ ÀÖ´Â º´¿ø¿¡ ÀÔ¿øÇÑ ¾î¸°ÀÌ¿Í Ã»¼Ò³âÀ» ´ë»óÀ¸·Î ¼Ò¾Æ Á¶±â °æº¸ Á¡¼ö(paediatric early warning score)¸¦ »ç¿ëÇÏ´Â °ÍÀ» °í·ÁÇϽʽÿÀ.

 

ÀÔ¿ø½Ã »ý¸®Àû °üÂûÀ» ±â·ÏÇÑ ´ÙÀ½ ¼Ò¾Æ Á¶±â °æ°í Á¡¼ö¿¡ ´ëÇÑ Áö¿ª ÇÁ·ÎÅäÄÝ¿¡ µû¶ó ±â·ÏÇϽʽÿÀ.

 

ºñÁ¤»óÀûÀÎ »ý¸®°¡ °¨ÁöµÇ¸é °üÂû ºóµµ¸¦ ´Ã¸®½Ê½Ã¿À

 

1.2.4 ¼Ò¾Æ Á¶±â °æº¸ Á¡¼ö¸¦ »ç¿ëÇÏ´Â °æ¿ì µî±ÞÀÌ ¸Å°ÜÁø ÀÀ´äÀ» Çã¿ëÇÏ´Â ´ÙÁß ¸Å°³ º¯¼ö ¶Ç´Â Áý°è °¡Áß Á¡¼ö ¸Å±â±â ½Ã½ºÅÛÀ» »ç¿ëÇϽʽÿÀ.

 

ÃøÁ¤ ÇÒ ¸Å°³ º¯¼ö ¹× °üÃø ºóµµ Á¤ÀÇ

 

ÀÀ´äÀ» À¯¹ßÇؾßÇÏ´Â ¸Å°³ º¯¼ö, ÄÆ¿ÀÇÁ Æ÷ÀÎÆ® ¶Ç´Â Á¡¼ö¿¡ ´ëÇÑ ¸íÈ®ÇÏ°í ¸í½ÃÀûÀÎ Áø¼úÀ» Æ÷ÇÔÇÕ´Ï´Ù. [2013]

 

1.2.5 ¼Ò¾Æ Á¶±â °æº¸ Á¡¼ö¸¦ »ç¿ëÇÏ´Â °æ¿ì ´ÙÀ½À» ÃøÁ¤ÇÏ´Â ´ÙÁß ¸Å°³ º¯¼ö ¶Ç´Â Áý°è °¡Áß Á¡¼ö ¸Å±â±â ½Ã½ºÅÛÀ» »ç¿ëÇϽʽÿÀ.

 

½É¹Ú¼ö(heart rate)

 

È£Èí(respiratory rate)

 

¼öÃà±â Ç÷¾Ð(systolic blood pressure)

 

ÀÇ½Ä ¼öÁØ(level of consciousness)

 

»ê¼Ò Æ÷È­(oxygen saturation)

 

ü¿Â(temperature)

 

¸ð¼¼°ü ¸®ÇÊ ½Ã°£(capillary refill time)


 

1.2.6 ¾î¸°ÀÌ¿Í Ã»¼Ò³âÀÌ ±Ç°í»çÇ׿¡ Æ÷ÇԵǾî ÀÖ´Â À§Çè ¿äÀÎÀ¸·Î ÀÎÇØ ±Þ¼º ½ÅÀå ¼Õ»óÀÇ À§ÇèÀÌ ÀÖ´Â °æ¿ì 1.1.2 :

 

¼Òº¯ Ãâ·Â ÃøÁ¤(measure urine output)

 

¼öºÐ±ÕÇüÀ» °áÁ¤Çϱâ À§ÇØ ¸ÅÀÏ µÎ ¹ø üÁßÀ» ±â·Ï(record weight twice daily to determine fluid balance)

 

¿ä¼Ò, Å©·¹¾ÆƼ´Ñ ¹× ÀüÇØÁú ÃøÁ¤(measure urea, creatinine and electrolytes)

 

Á¥»ê, Ç÷´ç ¹× Ç÷¾×°¡½º ÃøÁ¤¿¡ ´ëÇØ »ý°¢ÇϽʽÿÀ(think about measuring lactate, blood glucose and blood gases).



 

1.3 ±Þ¼º ½Å¼Õ»ó ±¸ºÐ(Detecting acute kidney injury)


 

1.3.1 ´ÙÀ½ ±âÁØ Áß Çϳª¸¦ »ç¿ëÇÏ¿© (p) RIFLE [1], AKIN [2] ¶Ç´Â KDIGO [3] Á¤ÀÇ¿¡ µû¶ó ±Þ¼º ½Å¼Õ»óÀ» ±¸º°ÇÑ´Ù

 

-48 ½Ã°£ À̳»¿¡ 26 μmol / ¸®ÅÍ ÀÌ»óÀÇ Ç÷û Å©·¹¾ÆƼ´Ñ Áõ°¡

 

-Áö³­ 7 ÀÏ À̳»¿¡ ¹ß»ýÇ߰ųª ¾Ë·ÁÁø °ÍÀ¸·Î ÃßÁ¤µÇ´Â Ç÷û Å©·¹¾ÆƼ´ÑÀÇ 50 % ÀÌ»ó Áõ°¡

 

-¼ºÀÎÀÇ °æ¿ì 6 ½Ã°£ ÀÌ»ó, ¾î¸°ÀÌ ¹× û¼Ò³âÀÇ °æ¿ì 8 ½Ã°£ ÀÌ»ó ¼Òº¯·®ÀÌ 0.5ml / kg / ½Ã°£ ¹Ì¸¸À¸·Î °¨¼Ò

 

-Áö³­ 7 ÀÏ µ¿¾È ¾î¸°ÀÌ¿Í Ã»¼Ò³âÀÇ eGFRÀÌ 25 % ÀÌ»ó °¨¼Ò [2013]

 

1.3.2 ±Þ¼º ½Å¼Õ»óÀÌ Àְųª ±Þ¼º½Å¼Õ»ó ¹ßº´ À§ÇèÀÌÀÖ´Â ¸ðµç ¼ºÀÎ, ¾î¸°ÀÌ ¹× û¼Ò³â¿¡¼­ Á¤±âÀûÀ¸·Î Ç÷û Å©·¹¾ÆƼ´ÑÀ» ¸ð´ÏÅ͸µÇÑ´Ù]. [2013]





 

URL: NICE (National Institute for Health and Care Excellence) Guideline on Acute kidney injury 

https://www.nice.org.uk/guidance/conditions-and-diseases/kidney-conditions/acute-kidney-injury

 

 


2020-01-07 ¿ÀÈÄ 6:04:13, Á¶È¸¼ö : 2494