Ronco Claudio, Legrand Matthieu, Goldstein Stuart L, Hur Mina, Tran Nam, Howell Eric C, Cantaluppi Vincenzo, Cruz Dinna N, Damman Kevin, Bagshaw Sean M, Di Somma Salvatore, Lewington Andrew
Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
Blood Purif. 2014;37(4):271-85. doi: 10.1159/000360689. Epub 2014 Jul 3.
Acute kidney injury (AKI) remains a challenge in terms of diagnosis and classification, its morbidity and mortality remaining high in the face of improving clinical protocols. Current clinical criteria use serum creatinine (sCr) and urine output to classify patients. Ongoing research has identified novel biomarkers that may improve the speed and accuracy of patient evaluation and prognostication, yet the route from basic science to clinical practice remains poorly paved. International evidence supporting the use of plasma neutrophil gelatinase-associated lipocalin (NGAL) as a valuable biomarker of AKI and chronic kidney disease (CKD) for a number of clinical scenarios was presented at the 31st International Vicenza Course on Critical Care Nephrology, and these data are detailed in this review. NGAL was shown to be highly useful alongside sCr, urinary output, and other biomarkers in assessing kidney injury; in patient stratification and continuous renal replacement therapy (CRRT) selection in paediatric AKI; in assessing kidney injury in conjunction with sCr in sepsis; in guiding resuscitation protocols in conjunction with brain natriuretic peptide in burn patients; as an early biomarker of delayed graft function and calcineurin inhibitor nephrotoxicity in kidney transplantation from extended criteria donors; as a biomarker of cardiovascular disease and heart failure, and in guiding CRRT selection in the intensive care unit and emergency department. While some applications require further clarification by way of larger randomised controlled trials, NGAL nevertheless demonstrates promise as an independent biological marker with the potential to improve earlier diagnosis and better assessment of risk groups in AKI and CKD. This is a critical element in formulating quick and accurate decisions for individual patients, both in acute scenarios and in long-term care, in order to improve patient prognostics and outcomes.
急性肾损伤（AKI）在诊断和分类方面仍然是一项挑战，尽管临床方案不断改进，但其发病率和死亡率仍然很高。目前的临床标准使用血清肌酐（sCr）和尿量来对患者进行分类。正在进行的研究已经确定了新的生物标志物，这些标志物可能会提高患者评估和预后的速度及准确性，但从基础科学到临床实践的道路仍然崎岖不平。在第31届国际维琴察重症监护肾脏病课程上，展示了支持在多种临床情况下将血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）用作AKI和慢性肾脏病（CKD）重要生物标志物的国际证据，本综述将详细介绍这些数据。研究表明，在评估肾损伤时，NGAL与sCr、尿量及其他生物标志物一起非常有用；在小儿AKI的患者分层和连续性肾脏替代治疗（CRRT）选择中；在脓毒症中与sCr联合评估肾损伤时；在烧伤患者中与脑钠肽联合指导复苏方案时；作为扩大标准供体肾移植中移植肾功能延迟和钙调神经磷酸酶抑制剂肾毒性的早期生物标志物；作为心血管疾病和心力衰竭的生物标志物，以及在重症监护病房和急诊科指导CRRT选择时。虽然一些应用需要通过更大规模的随机对照试验进一步阐明，但NGAL作为一种独立的生物标志物仍显示出前景，有可能改善AKI和CKD中更早的诊断以及对风险组的更好评估。这是在急性情况和长期护理中为个体患者做出快速准确决策的关键因素，以便改善患者的预后和结局。
