Hawkins Robert
Department of Laboratory Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore.
Korean J Lab Med. 2011 Apr;31(2):72-80. doi: 10.3343/kjlm.2011.31.2.72.
Changes in renal function are one of the most common manifestations of severe illness. There is a clinical need to intervene early with proven treatments in patients with potentially deleterious changes in renal function. Unfortunately progress has been hindered by poor definitions of renal dysfunction and a lack of early biomarkers of renal injury. In recent years, the definitional problem has been addressed with the establishment of a new well-defined diagnostic entity, acute kidney injury (AKI), which encompasses the wide spectrum of kidney dysfunction, together with clearer definition and sub-classification of the cardio-renal syndromes. From the laboratory have emerged new biomarkers which allow early detection of AKI, including neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C. This review describes the new concepts of AKI and the cardio-renal syndromes as well as novel biomarkers which allow early detection of AKI. Panels of AKI biomarker tests are likely to revolutionize the diagnosis and management of critically ill patients in the coming years. Earlier diagnosis and intervention should significantly reduce the morbidity and mortality associated with acute kidney damage.
肾功能变化是重症最常见的表现之一。临床上需要对肾功能有潜在有害变化的患者尽早采用经证实的治疗方法进行干预。不幸的是，肾功能障碍定义不明确以及缺乏肾损伤早期生物标志物阻碍了这方面的进展。近年来，随着一种新的定义明确的诊断实体——急性肾损伤（AKI）的建立，定义问题得到了解决，AKI涵盖了广泛的肾功能障碍范围，同时对心肾综合征有了更清晰的定义和亚分类。实验室已出现了能够早期检测AKI的新生物标志物，包括中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素C。本综述描述了AKI和心肾综合征的新概念以及能够早期检测AKI的新型生物标志物。未来几年，AKI生物标志物检测组合可能会彻底改变危重症患者的诊断和管理。早期诊断和干预应能显著降低与急性肾损伤相关的发病率和死亡率。
