Issa Naim, Messer Jennifer, Paganini Emil P
Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Contrib Nephrol. 2007;156:419-27. doi: 10.1159/000102133.
Acute kidney injury (AKI) is a frequent and serious complication of sepsis in ICU patients and is associated with a very high mortality. Despite the advent of sophisticated renal replacement therapies (RRT) employing high-dose hemofiltration and high-flux membranes, mortality and morbidity from sepsis-induced AKI remained high. Moreover, these dialytic modalities could not substitute for the important functions of renal tubular cells in decreasing sepsis-induced AKI biological dysregulations. The results from the in vitro and preclinical animal model studies were very intriguing and led to the development of a bioartificial kidney consisting of a renal tubule assist device containing human proximal tubular cells (RAD) added in tandem to a continuous venovenous hemofiltration circuit. The results from the phase I safety trial and the recent phase II clinical trial showed that the RAD not only can replace many of the indispensable biological kidney functions, but also modify the natural history of sepsis-induced AKI by ameliorating patient survival.
急性肾损伤（AKI）是重症监护病房（ICU）患者脓毒症常见且严重的并发症，与极高的死亡率相关。尽管出现了采用高剂量血液滤过和高通量膜的复杂肾脏替代疗法（RRT），脓毒症诱导的AKI的死亡率和发病率仍然很高。此外，这些透析方式无法替代肾小管细胞在减少脓毒症诱导的AKI生物失调方面的重要功能。体外和临床前动物模型研究的结果非常有趣，并促成了一种生物人工肾的开发，该生物人工肾由一个包含人近端肾小管细胞的肾小管辅助装置（RAD）串联到连续静脉-静脉血液滤过回路组成。I期安全性试验和最近的II期临床试验结果表明，RAD不仅可以替代许多不可或缺的肾脏生物学功能，还可以通过改善患者生存率来改变脓毒症诱导的AKI的自然病程。
