McCullough Peter A, Shaw Andrew D, Haase Michael, Bouchard Josee, Waikar Sushrut S, Siew Edward D, Murray Patrick T, Mehta Ravindra L, Ronco Claudio
St. John Providence Health System, Detroit, MI, USA.
Contrib Nephrol. 2013;182:13-29. doi: 10.1159/000349963. Epub 2013 May 13.
Acute kidney injury (AKI) commonly occurs in hospitalized patients and is independently and strongly associates with morbidity and mortality. The clinical benefits of a timely and definitive diagnosis of AKI have not been fully realized due to limitations imposed by the use of serum creatinine and urine output to fulfill diagnostic criteria. These restrictions often lead to diagnostic delays, potential misclassification of actual injury status, and provide little information regarding underlying cause. Novel biomarkers of damage have shown ability to reflect ongoing kidney injury and help further refine existing Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) and Acute Kidney Injury Network (AKIN) diagnostic criteria. A comprehensive review of the published literature to date was performed using previously published methodology of the Acute Dialysis Quality Initiative (ADQI) working group to establish consensus statements regarding (i) the overall implementation of injury biomarkers in the concept of AKI diagnosis, (ii) their clinical use, and (iii) future research. On the basis of published data on the ability of novel damage biomarkers to provide diagnostic and prognostic information on AKI, we recommend that novel damage biomarkers may, in the appropriate clinical setting and context (situation consistent with AKI), be used to diagnose AKI even in the absence of changes in serum creatinine or the presence of oliguria as described in the existing RIFLE/AKIN criteria for diagnosis of AKI. Adding injury biomarkers as a criterion for AKI will complement the ability of RIFLE/AKIN to define AKI. Promising diagnostic injury markers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (IL-18) and liver-type fatty acid binding protein (L-FABP). However, there are currently insufficient data on damage biomarkers to support their use for AKI staging. Rigorous validation studies measuring the association between the novel damage biomarker(s) and clinically relevant outcomes are needed.
急性肾损伤（AKI）常见于住院患者，并且与发病率和死亡率独立且密切相关。由于使用血清肌酐和尿量来满足诊断标准存在局限性，及时、明确诊断AKI的临床益处尚未得到充分实现。这些限制常常导致诊断延迟、实际损伤状态的潜在错误分类，并且几乎无法提供有关潜在病因的信息。新型损伤生物标志物已显示出能够反映正在发生的肾损伤，并有助于进一步完善现有的风险、损伤、衰竭、失功、终末期肾病（RIFLE）和急性肾损伤网络（AKIN）诊断标准。使用急性透析质量倡议（ADQI）工作组先前发表的方法，对迄今为止已发表的文献进行了全面综述，以就以下方面建立共识声明：（i）损伤生物标志物在AKI诊断概念中的总体应用；（ii）它们的临床用途；（iii）未来研究。基于已发表的关于新型损伤生物标志物提供AKI诊断和预后信息能力的数据，我们建议，在适当的临床环境和背景（与AKI一致的情况）下，即使在血清肌酐没有变化或不存在少尿的情况下（如现有RIFLE/AKIN AKI诊断标准中所述），新型损伤生物标志物也可用于诊断AKI。将损伤生物标志物作为AKI的一项标准将补充RIFLE/AKIN定义AKI的能力。有前景的诊断性损伤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）、白细胞介素18（IL-18）和肝型脂肪酸结合蛋白（L-FABP）。然而，目前关于损伤生物标志物的数据不足以支持将其用于AKI分期。需要进行严格的验证研究，以测量新型损伤生物标志物与临床相关结局之间的关联。
