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急性肾损伤(AKI)生物标志物。

Acute Kidney Injury (AKI) biomarker.

作者信息

Adiyanti Sri S, Loho Tonny

机构信息

Department of Clinical Pathology, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

出版信息

Acta Med Indones. 2012 Jul;44(3):246-55.

Abstract

The kidney has a remarkable capacity to withstand insults for an extended period of time. The sensitivities of individual renal cells to injury vary depending on their type, position in the nephron, local vascularization, and the nature of injury. The resulting kidney injury is a product of the interplay between cell dysfunction, cell death, proliferation, inflammation, and recovery. The Acute Kidney Injury Network (AKIN) defined Acute Kidney Injury (AKI) as "functional and structural disorder or signs of renal damage including any defect from blood and urine test, or tissue imaging that is less than 3 months". RIFLE (Risk, Injury, Failure, Loss, End-Stage Kidney Disease) criteria is the most frequently used system. Ideal biomarker for AKI should be affordable, quick and measurable, precise and accurate, with prognostic ability to define severity of renal dysfunction, specific for renal, increase in the early stage dysfunction, with high sensitivity and specificity. Efforts to detect AKI in the earlier stage has resulted in some promising biomarkers such as KIM-1, NGAL, IL-18, Clusterin, etc. Cystatin C is a biomarker for glomerular filtration function, while 2-microglobulin, 1-microglobulin, NAG, RBP, IL-18, NGAL, Netrin-1, KIM-1, Clusterin, Sodium Hydrogen Exchanger Isoform and Fetuin A are biomarkers for tubular reabsorption function.

摘要

肾脏具有在较长时间内抵御损伤的显著能力。单个肾细胞对损伤的敏感性因其类型、在肾单位中的位置、局部血管化情况以及损伤的性质而异。由此产生的肾损伤是细胞功能障碍、细胞死亡、增殖、炎症和恢复之间相互作用的结果。急性肾损伤网络(AKIN)将急性肾损伤(AKI)定义为“功能和结构紊乱或肾损伤迹象,包括血液和尿液检测或组织成像的任何缺陷,且持续时间少于3个月”。RIFLE(风险、损伤、衰竭、失功、终末期肾病)标准是最常用的系统。理想的急性肾损伤生物标志物应价格低廉、检测快速且可测量、精确准确,具有定义肾功能障碍严重程度的预后能力,对肾脏具有特异性,在功能障碍早期升高,且具有高敏感性和特异性。在早期阶段检测急性肾损伤的努力已产生了一些有前景的生物标志物,如KIM-1、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白细胞介素-18(IL-18)、簇集蛋白等。胱抑素C是肾小球滤过功能的生物标志物,而β2-微球蛋白、α1-微球蛋白、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)、IL-18、NGAL、网蛋白-1、KIM-1、簇集蛋白、钠氢交换体异构体和胎球蛋白A是肾小管重吸收功能的生物标志物。

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