3．急性腎障害に対するアプローチ—発生場所/基礎疾患による分類

Classification of AKI by location of occurrence and underlying condition

さまざまな病態を背景とした急性腎障害（AKI）に関して研究が進み，古典的な腎前性/腎性/腎後性という分類とは異なるアプローチが求められるようになっている。ICU・救急外来におけるAKIの特徴と，心腎連関，敗血症性AKI，心臓手術関連AKI，肝腎症候群，腹部コンパートメント症候群に伴うAKIを取り上げその機序や治療法を概説する。どの病態も血行動態，神経体液性因子の異常，炎症や代謝，薬物などが複雑に関与し，多角的な管理が必要と考えられる。腎代替療法では近年，個々の病態やdialytraumaを考慮しつつ，さまざまな透析手法に視野を広げた対応が試みられている。

Studies on acute kidney injury （AKI） with a variety of pathophysiological backgrounds are being conducted, and approaches to AKI different from the traditional prerenal/renal/postrenal classification are required. The characteristics of AKI in the intensive care unit and emergency room and the mechanisms and treatment methods for cardiorenal syndrome, septic AKI, cardiac surgery-associated AKI, hepatorenal syndrome, and abdominal compartment syndrome were reviewed. In all of these syndromes, hemodynamics, abnormalities in neurohumoral factors, inflammation, metabolism, and drugs are involved in a complex manner. Management using multiple approaches is necessary for treatment. In recent years, renal replacement therapy has been performed using various dialysis techniques, taking into account individual pathophysiology and dialytrauma.