Himmelfarb J, Ikizler T A
Maine Medical Center, Portland, ME and Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kidney Int. 2007 May;71(10):971-6. doi: 10.1038/sj.ki.5002224. Epub 2007 Mar 28.
In recent years, there have been numerous advances in understanding the molecular determinants of functional kidney injury after ischemic and/or toxic exposure. However, translation of successful novel therapies designed to attenuate kidney functional injury from animal models to the clinical sphere has had modest results. This lack of translatability is at least in part due to lack of sufficient standardization in definitions and classification of cases of acute kidney injury (AKI), an incomplete understanding of the natural history of human AKI, and a limited understanding of how kidney injury interacts with other organ system failure in the context of systemic metabolic abnormalities. A concerted effort is now being made by nephrologists and intensivists to arrive at standardized terminology and classification of AKI. There have also been dramatic advances in our understanding of the epidemiology and natural history of AKI, particularly in the hospital and intensive care unit setting. Promising strategies are now being developed which may ultimately lead to improved outcomes for patients at risk for or who have developed AKI, which should be readily testable in the coming decade.
近年来，在理解缺血和/或毒性暴露后功能性肾损伤的分子决定因素方面取得了众多进展。然而，旨在减轻肾功能性损伤的成功新疗法从动物模型向临床领域的转化成果有限。这种缺乏可转化性至少部分归因于急性肾损伤（AKI）病例定义和分类缺乏足够的标准化、对人类AKI自然病程的不完全理解，以及对在全身代谢异常背景下肾损伤如何与其他器官系统衰竭相互作用的有限理解。肾病学家和重症监护专家目前正在共同努力，以达成AKI的标准化术语和分类。我们对AKI的流行病学和自然病程的理解也取得了显著进展，尤其是在医院和重症监护病房环境中。目前正在开发有前景的策略，这最终可能改善有AKI风险或已发生AKI的患者的预后，这些策略在未来十年应易于进行测试。
