近年來，隨著醫療不斷發展進步，急性腎損傷(Acute kidney injury, AKI)的發生率及盛行率不斷增加，重症患者常因敗血症及低血容性休克合併急性腎損傷，而重症患者合併急性腎損傷的死亡率往往高達50%以上。雖然這幾年對急性腎損傷的致病機轉及早期診斷的新式生物標記有越來越多的研究，但是對急性腎損傷的預防處理方法仍然進步不多。傳統上腎衰竭之支持療法，包括輸液的補充維持腎臟灌流、減少腎毒性藥物使用、及腎臟替代療法(renal replacement therapy)迄今仍未能有一致的治療共識。此外，近幾年重症透析不斷發展，對於透析劑量(Dialysis dose)，透析開始和結束時機，急性腎損傷營養補充，利尿劑和腎素-血管張力系統(RAS)拮抗劑使用也有不同於以往的觀念。因此，本文將根據實證醫學的角度，針對重症合併急性腎損傷病人的輸液治療，重症透析及藥物使用做進一步的討論。

Although the understanding of the causes, mechanisms and early diagnostic biomarkers of acute kidney injury (AKI) is improving, the disease’s occurrence, short-term and long-term complications are diffcult to prevent. We propose three updated strategies to preserve kidney function and minimize further kidney injury in patients with AKI. These include fluid management, kidney support during advanced AKI, use of renin–angiotensin system antagonists, and use of diuretics to achieve adequate control of intravascular volume. In addition, we describe the clinical implications of the effect of fluid restriction, the choice of fluid solutions and time to initiate par-enteral nutrition. Finally, we update the timing of dialysis initiation, and weaning from dialysis. Although therapies for ameliorating AKI per se remain limited, the potentially powerful strategies could modulate the intensity and poor outcome of AKI. (J Intern Med Taiwan 2014; 25: 75-81)