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Insuffisances rénales aiguës : pertinence d’une classification fondée sur le délai de récupération

Acute renal failure: Accuracy of a classification based on time to recovery

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Réanimation

Résumé

L’insuffisance rénale aiguë (IRA) est classiquement décrite selon le mécanisme physiopathologique estimé de l’atteinte rénale. Cette classification permet de proposer un algorithme décisionnel simple et pratique qui, après avoir éliminé une cause obstructive, fait la distinction entre atteintes fonctionnelles, liées à une hypoperfusion rénale, et atteintes organiques, liées à une atteinte parenchymateuse. Cette classification théorique est actuellement remise en cause, notamment en raison de l’intrication de plusieurs mécanismes et d’un continuum entre ces derniers. Une classification fondée sur la réversibilité à court terme pourrait permettre une approche clinique et expérimentale simple, avec des débouchés cliniques immédiats. Dans cette revue, nous évaluerons les motifs de la remise en cause de la dichotomie classique « IRA fonctionnelle »/« IRA organique » ainsi que les arguments soutenant une définition fondée sur le délai avant récupération.

Abstract

Among the suspected mechanisms of acute kidney injury (AKI), pre-renal AKI has long been differentiated from other subtypes of AKI, such as acute tubular necrosis (ATN). This distinction has been challenged by several recent studies. Thus, recent studies reported typical histopathological findings of ATN to be fairly uncommon in both experimental and human studies and its features to be patchy patchy. The classic pre-renal/intrinsic paradigm has been revisited and AKI are now mainly separated according to shortterm reversibility of AKI. In this article, we will review the findings supporting such change and the potential interest for research purposes or at bedside in reporting AKI according to short-term reversibility.

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Authors and Affiliations

  1. Service de réanimation polyvalente, CHU de Saint-Étienne et université Jean-Monnet, F-42270, Saint-Étienne, France

    S. Perinel & M. Darmon

  2. Groupe de recherche thrombose, EA 3065, université Jean-Monnet, Saint-Étienne, France

    M. Darmon

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  1. S. Perinel
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  2. M. Darmon
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Correspondence to M. Darmon.

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Perinel, S., Darmon, M. Insuffisances rénales aiguës : pertinence d’une classification fondée sur le délai de récupération. Réanimation 24, 648–653 (2015). https://doi.org/10.1007/s13546-015-1112-4

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  • DOI: https://doi.org/10.1007/s13546-015-1112-4

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