Section of Nephrology, Yale University School of Medicine, BB 114, 330 Cedar Street, New Haven, CT 06520-8029, USA.
Clin J Am Soc Nephrol. 2012 Jan;7(1):167-74. doi: 10.2215/CJN.09490911. Epub 2011 Nov 17.
Traditional biomarkers, such as urine chemistries and urine microscopic elements, are used in the diagnosis and care of patients with AKI. Urine chemistries, such as fractional excretion of sodium and fractional excretion of urea, are useful for differentiating prerenal AKI from acute tubular necrosis only in select patients. Urine microscopy using a quantitative evaluation of the urine sediment for renal tubular epithelial cells, renal tubular epithelial cell casts, and granular casts has recently been shown to differentiate prerenal AKI from acute tubular necrosis and also provide prognostic information. Urine microscopy has also been noted to compare favorably with new urine biomarkers for diagnosis and prognosis of AKI. Thus, current information on urine diagnostics suggests that urine chemistries have a limited role in differential diagnosis of AKI, whereas urine microscopy and new urine biomarkers may be used together to differentiate prerenal AKI from acute tubular necrosis and predict such outcomes as worsened AKI, acute dialysis, and death.
传统的生物标志物，如尿液化学和尿液微量元素，用于 AKI 患者的诊断和护理。尿液化学，如钠的分数排泄和尿素的分数排泄，仅在某些患者中对鉴别肾前性 AKI 与急性肾小管坏死有用。最近已经表明，使用尿液沉淀物的定量评估来检查肾小管上皮细胞、肾小管上皮细胞 casts 和颗粒 casts 的尿液显微镜检查可区分肾前性 AKI 与急性肾小管坏死，并提供预后信息。尿液显微镜检查也被认为与新的尿液生物标志物在 AKI 的诊断和预后方面具有可比性。因此，目前关于尿液诊断的信息表明，尿液化学在 AKI 的鉴别诊断中作用有限，而尿液显微镜检查和新的尿液生物标志物可一起用于区分肾前性 AKI 与急性肾小管坏死，并预测 AKI 恶化、急性透析和死亡等结果。
