Waikar Sushrut S, Bonventre Joseph V
Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Curr Opin Nephrol Hypertens. 2007 Nov;16(6):557-64. doi: 10.1097/MNH.0b013e3282f08745.
The identification of acute kidney injury relies on tests like blood urea nitrogen and serum creatinine that were identified and incorporated into clinical practice several decades ago. This review summarizes clinical studies of newer biomarkers that may permit earlier and more accurate identification of acute kidney injury.
The urine may contain sensitive and specific markers of kidney injury that are present due to either impaired tubular reabsorption and catabolism of filtered molecules or release of tubular cell proteins in response to ischemic or nephrotoxic injury. Many potential markers have been studied. Promising injury markers in the urine include N-acetyl-beta-D-glucosaminidase, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18. Serum cystatin C may be a better measure of glomerular filtration rate than serum creatinine or blood urea nitrogen.
New biomarkers of kidney injury and glomerular filtration rate hold the promise of substantially improving the diagnostic approach to acute kidney injury. Adequately powered clinical studies of multiple biomarkers are needed to qualify the biomarkers before they can be fully adopted in clinical practice. Once adopted, more sensitive biomarkers of acute kidney injury hold the potential to transform the care of patients with renal disease.
急性肾损伤的识别依赖于血尿素氮和血清肌酐等检测指标，这些指标在几十年前就已被确定并应用于临床实践。本综述总结了关于新型生物标志物的临床研究，这些生物标志物可能有助于更早、更准确地识别急性肾损伤。
尿液中可能含有肾脏损伤的敏感且特异的标志物，这些标志物的出现是由于滤过分子的肾小管重吸收和分解代谢受损，或者是肾小管细胞因缺血或肾毒性损伤而释放蛋白质。许多潜在的标志物已被研究。尿液中颇具前景的损伤标志物包括N - 乙酰 - β - D - 氨基葡萄糖苷酶、中性粒细胞明胶酶相关脂质运载蛋白、肾损伤分子 - 1和白细胞介素 - 18。血清胱抑素C可能比血清肌酐或血尿素氮更能准确反映肾小球滤过率。
肾脏损伤和肾小球滤过率的新型生物标志物有望显著改善急性肾损伤的诊断方法。在这些生物标志物能够在临床实践中全面应用之前，需要开展足够样本量的多种生物标志物的临床研究以验证其有效性。一旦被采用，更敏感的急性肾损伤生物标志物有可能改变肾病患者的治疗方式。
