Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio 45229-3039, USA.
Curr Opin Pediatr. 2011 Apr;23(2):194-200. doi: 10.1097/MOP.0b013e328343f4dd.
Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which depends on serum creatinine, which is a delayed and unreliable indicator of AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The current status of the most promising of these novel AKI biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), and interleukin (IL)-18, is reviewed.
In particular, NGAL is emerging as an excellent biomarker in the urine and plasma, for the early prediction of AKI, for monitoring clinical trials in AKI, and for the prognosis of AKI in several common clinical scenarios. However, biomarker combinations may be required to improve our ability to predict AKI and its outcomes in a context-specific manner.
It is vital that additional large future studies demonstrate the association between biomarkers and hard clinical outcomes independent of serum creatinine concentrations and that randomization to a treatment for AKI based on high biomarker levels results in an improvement in clinical outcomes.
急性肾损伤（AKI）是一种常见且严重的疾病，其诊断依赖于血清肌酐，而后者是 AKI 的一个延迟且不可靠的指标。幸运的是，人们对肾脏对急性损伤的早期应激反应的认识，揭示了许多潜在的生物标志物。本文对其中最有前途的几种新型 AKI 生物标志物（包括中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）、肝型脂肪酸结合蛋白（L-FABP）和白细胞介素（IL）-18）的最新研究进展进行了综述。
特别是，NGAL 作为尿液和血浆中 AKI 的早期预测、AKI 临床试验监测以及几种常见临床情况下 AKI 预后的优秀生物标志物，正逐渐受到关注。然而，可能需要生物标志物组合来提高我们以特定于具体情况的方式预测 AKI 及其结局的能力。
未来的大型研究需要进一步证实生物标志物与独立于血清肌酐浓度的硬临床结局之间的关系，并且基于高生物标志物水平对 AKI 进行治疗的随机分组是否能改善临床结局。
