Goldstein Stuart L, Devarajan Prasad
Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA.
Adv Chronic Kidney Dis. 2008 Jul;15(3):278-83. doi: 10.1053/j.ackd.2008.04.007.
Although emerging evidence indicates that the incidence of both acute kidney injury (AKI) and chronic kidney disease (CKD) in children is rising and the etiologies are dramatically changing, relatively little is currently known regarding the potential for transition from AKI to CKD. In both situations, early intervention can significantly improve the dismal prognosis. However, the lack of a uniform AKI definition and the paucity of early, predictive biomarkers have impaired our ability diagnose AKI early to institute potentially effective therapies in a timely manner. Fortunately, recent data has validated a multidimensional AKI classification system for children. In addition, the application of innovative technologies has identified candidates that are emerging as early biomarkers of both AKI and CKD. These include neutrophil gelatinase-associated lipocalin, liver-type fatty acid-binding protein, and kidney injury molecule-1. Studies to validate the sensitivity and specificity of these biomarkers in clinical samples from large cohorts and from multiple clinical situations are currently in progress, facilitated by the development of commercial tools for the reproducible measurement of these biomarkers across different laboratories.
尽管新出现的证据表明儿童急性肾损伤（AKI）和慢性肾脏病（CKD）的发病率均在上升，且病因正在发生显著变化，但目前对于AKI向CKD转变的可能性了解相对较少。在这两种情况下，早期干预均可显著改善预后不佳的状况。然而，缺乏统一的AKI定义以及早期预测性生物标志物，削弱了我们早期诊断AKI以便及时采取潜在有效治疗措施的能力。幸运的是，最近的数据验证了一种针对儿童的多维AKI分类系统。此外，创新技术的应用已经确定了一些有望成为AKI和CKD早期生物标志物的候选物质。这些物质包括中性粒细胞明胶酶相关脂质运载蛋白、肝型脂肪酸结合蛋白和肾损伤分子-1。目前正在开展研究，以验证这些生物标志物在来自大型队列和多种临床情况的临床样本中的敏感性和特异性，不同实验室可通过开发用于可重复测量这些生物标志物的商业工具来推动此项研究。
