Vanholder R, Meert N, Schepers E, Glorieux G
Nephrology Section, University Hospital, Gent, Belgium.
Contrib Nephrol. 2008;161:125-131. doi: 10.1159/000130657.
The uremic syndrome is defined by a complex clinical picture, characterized by the dysfunction of most organs which are affected by the retention of multiple solutes. Recent research has helped to unravel the pathophysiology and to identify several as yet unknown responsible compounds. In this publication, we summarize which compounds play the most important pathophysiologic role, and which dialysis strategies can be considered to decrease their concentration and improve outcomes. The main pathophysiologic role is played by molecules which are so-called 'difficult to remove by dialysis'. Essentially observational studies have suggested that enhancement of removal of these molecules, by improving convection (hemodiafiltration), creates an improvement of survival. The knowledge of uremic toxicity is still far from complete however, and we need extra information about responsible compounds and mechanisms, eventually leading to a classification of the most important culprits, to allow the development of even more efficient or specific removal strategies.
尿毒症综合征由复杂的临床表现所定义，其特征为多数器官功能障碍，这些器官受到多种溶质潴留的影响。近期研究有助于阐明其病理生理学，并识别出几种此前未知的致病化合物。在本出版物中，我们总结了哪些化合物发挥着最重要的病理生理作用，以及可以考虑哪些透析策略来降低它们的浓度并改善预后。主要的病理生理作用由所谓“难以通过透析清除”的分子发挥。本质上，观察性研究表明，通过改善对流（血液透析滤过）增强这些分子的清除，可改善生存率。然而，关于尿毒症毒性的知识仍远未完善，我们需要有关致病化合物和机制的更多信息，最终对最重要的罪魁祸首进行分类，以便开发出更高效或更具特异性的清除策略。
