Hull Travis D, Agarwal Anupam, Hoyt Kenneth
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
J Am Soc Nephrol. 2017 Dec;28(12):3452-3460. doi: 10.1681/ASN.2017060647. Epub 2017 Sep 18.
AKI and CKD are important clinical problems because they affect many patients and the associated diagnostic and treatment paradigms are imperfect. Ultrasound is a cost-effective, noninvasive, and simple imaging modality that offers a multitude of means to improve the diagnosis, monitoring, and treatment of both AKI and CKD, especially considering recent advances in this technique. Ultrasound alone can attenuate AKI and prevent CKD by stimulating the splenic cholinergic anti-inflammatory pathway. Additionally, microbubble contrast agents are improving the sensitivity and specificity of ultrasound for diagnosing kidney disease, especially when these agents are conjugated to ligand-specific mAbs or peptides, which make the dynamic assessment of disease progression and response to treatment possible. More recently, drug-loaded microbubbles have been developed and the load release by ultrasound exposure has been shown to be a highly specific treatment modality, making the potential applications of ultrasound even more promising. This review focuses on the multiple strategies for using ultrasound with and without microbubble technology for enhancing our understanding of the pathophysiology of AKI and CKD.
急性肾损伤（AKI）和慢性肾脏病（CKD）是重要的临床问题，因为它们影响众多患者，且相关的诊断和治疗模式并不完善。超声是一种经济高效、无创且操作简单的成像方式，它提供了多种手段来改善AKI和CKD的诊断、监测及治疗，尤其是考虑到该技术的最新进展。单独使用超声可通过刺激脾脏胆碱能抗炎途径减轻AKI并预防CKD。此外，微泡造影剂正在提高超声诊断肾脏疾病的敏感性和特异性，特别是当这些造影剂与配体特异性单克隆抗体或肽结合时，这使得对疾病进展和治疗反应进行动态评估成为可能。最近，已开发出载药微泡，并且已证明通过超声照射实现的药物释放是一种高度特异性的治疗方式，这使得超声的潜在应用更具前景。本综述重点关注使用超声结合或不结合微泡技术的多种策略，以增进我们对AKI和CKD病理生理学的理解。
