医院获得性急性肾衰竭(Hospital-Acquired acute renal failure,H-AARF)指医疗干预(药物、造影、手术等)所致肾功能短期内进行性下降甚至少尿、无尿,属医源性疾病。H-AARF在住院患者中发生率为2%~5%,在冠脉造影者中的发生率为14.5%,合并本症后患者住院时间延长,住院费用增加,病死率升高。经治医师在诊疗过程中如认真权衡每个诊疗措施,对患者的利弊并采取必要的预防措施,就可能少发生这类并发症。1 致H-AARF的原因及机制1．1 有效血容量不足有效血容量不足致肾低灌注、肾缺血致急性肾衰竭(ARF)。①绝对有效血容量不足:失血、胃肠液丢失(吐、泻、鼻胃管引流),大汗、外伤、大手术、烧伤、大面积皮肤糜烂渗液、摄入不足或经肾丢失,如ARF多尿期、不适当应用利 Hospital-Acquired acute renal failure (H-AARF) refers to the short-term decline of renal function due to medical intervention (drug, radiography, surgery, etc.). Even oliguria and anuria are iatrogenic diseases . The incidence of H-AARF in hospitalized patients was 2% to 5%, and that of H-AARF was 14.5% in coronary angiographers. The hospitalization of patients with H-AARF prolonged, the cost of hospitalization increased, and the mortality increased. It is possible that the attending physician may weigh fewer complications during the course of treatment, such as careful weighing of each diagnosis and treatment, the pros and cons of the patient and taking the necessary precautions. 1 induced H-AARF causes and mechanisms 1.1 lack of effective hypovolemia hypogonadism, renal ischemia caused by acute renal failure (ARF). ① absolute effective hypovolemia: blood loss, loss of gastrointestinal fluid (spit, diarrhea, nasogastric drainage), sweating, trauma, major surgery, burns, extensive skin erosion exudate, inadequate intake or loss of the kidney, such as ARF polyuria, improper use of Lee