Okusa Mark D, Jaber Bertrand L, Doran Peter, Duranteau Jacques, Yang Li, Murray Patrick T, Mehta Ravindra L, Ince Can
Division of Nephrology and Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Va., USA.
Contrib Nephrol. 2013;182:65-81. doi: 10.1159/000349967. Epub 2013 May 13.
The past 5-10 years have brought significant advances in the identification and validation of novel biochemical biomarkers in the prevention and treatment of acute kidney injury (AKI). These biochemical biomarkers remain research tools but we anticipate that soon they will be employed in clinical practice. A Consensus Conference held by the Acute Dialysis Quality Initiative (ADQI) recently reviewed the evidence, and identified gaps and a research agenda. Furthermore, at this meeting was the birth of an initiative to comprehensively identify new opportunities to characterize the physiological changes during the course of AKI based upon a conceptual framework for the detection and monitoring of renal ischemia-reperfusion injury. This framework includes a transition from monitoring physiological biomarkers of adequate renal perfusion, to pathophysiologic biomarkers of renal hypoperfusion, and finally biomarkers of kidney cell structural injury/damage. Techniques to measure physiological changes in AKI include several physiological variables that might be used in an interactive way to supplement clinical information and biochemical damage biomarkers in the diagnosis and management of AKI. This review summarizes the spectrum of physiological parameters and potential new physiological methods that enable identification of high-risk patients for AKI, facilitate early diagnosis, and differential diagnosis to guide therapeutic management and prognostication. Finally, we propose a research agenda for the next 5 years to facilitate the development and validation of physiological biomarkers in AKI.
在过去5至10年中，新型生化生物标志物在急性肾损伤（AKI）预防和治疗中的识别与验证取得了重大进展。这些生化生物标志物目前仍为研究工具，但我们预计它们很快将应用于临床实践。急性透析质量倡议组织（ADQI）近期召开的一次共识会议对相关证据进行了审查，确定了差距并制定了研究议程。此外，在此次会议上还诞生了一项倡议，该倡议基于检测和监测肾缺血再灌注损伤的概念框架，全面识别在AKI病程中表征生理变化的新机会。这个框架包括从监测充足肾灌注的生理生物标志物，过渡到肾灌注不足的病理生理生物标志物，最终到肾细胞结构损伤/损害的生物标志物。测量AKI生理变化的技术包括几个生理变量，这些变量可以交互方式用于补充临床信息以及AKI诊断和管理中的生化损伤生物标志物。本综述总结了生理参数的范围以及潜在的新生理方法，这些方法能够识别AKI的高危患者、促进早期诊断以及进行鉴别诊断以指导治疗管理和预后评估。最后，我们提出了未来5年的研究议程，以促进AKI生理生物标志物的开发和验证。
