Christchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand.
Am J Physiol Renal Physiol. 2011 Oct;301(4):F697-707. doi: 10.1152/ajprenal.00448.2010. Epub 2011 Jul 13.
Acute kidney injury (AKI) is a common and frequently fatal illness in critically ill patients. The reliance on daily measurements of serum creatinine as a surrogate of glomerular filtration rate (GFR) not only delays diagnosis and development of successful therapies but also hinders insight into the pathophysiology of human AKI. Measurement of GFR under non-steady-state conditions remains an elusive gold standard against which biomarkers of renal injury need to be judged. Approaches to the rapid (near real-time) measurement of GFR are explored. Even if real-time GFR was available, absent baseline information will always limit diagnosis of AKI based on GFR or serum creatinine to a detection of change. Biomarkers of renal cellular injury have provided new strategies to facilitate detection and early intervention in AKI. However, the diagnostic and predictive performance of urinary biomarkers of injury vary, depending on both the time after renal injury and on the preinjury GFR. Progress in understanding the role of each novel biomarker in the causal pathways of AKI promises to enhance their diagnostic potential. We predict that combining rapid measures of GFR with biomarkers of renal injury will yield substantive progress in the treatment of AKI.
急性肾损伤 (AKI) 是危重症患者中常见且经常致命的疾病。依赖于每日测量血清肌酐作为肾小球滤过率 (GFR) 的替代物不仅会延迟诊断和成功治疗方法的开发，还会阻碍对人类 AKI 病理生理学的深入了解。在非稳态条件下测量 GFR 仍然是一个难以捉摸的黄金标准，需要根据该标准来判断肾损伤的生物标志物。目前正在探索快速（接近实时）测量 GFR 的方法。即使实时 GFR 可用，如果没有基线信息，基于 GFR 或血清肌酐的 AKI 诊断将始终限于检测变化。肾细胞损伤的生物标志物为 AKI 的检测和早期干预提供了新策略。然而，损伤生物标志物的诊断和预测性能因肾损伤后时间和损伤前 GFR 而异。对每种新型生物标志物在 AKI 因果途径中的作用的理解的进展有望增强其诊断潜力。我们预测，将快速测量 GFR 与肾损伤生物标志物相结合，将在 AKI 的治疗方面取得实质性进展。
