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儿童造血干细胞移植后急性肾损伤的标志物。

Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation.

机构信息

Department of Pediatric Nephrology, Wroclaw Medical University, Poland.

Department of Bone Marrow Transplantation, Oncology and Pediatric Hematology, Wroclaw Medical University, Poland.

出版信息

Adv Clin Exp Med. 2019 Aug;28(8):1111-1118. doi: 10.17219/acem/101573.

Abstract

Acute kidney injury (AKI), one of the major complications in children undergoing hematopoietic stem cell transplantation (HSCT), is an independent predictor of the patient's survival and a prognostic factor of progression to chronic kidney disease (CKD). Despite the multifaceted role of AKI, its early diagnosis in the course of HSCT remains a challenge. These difficulties may result from the inefficiency of traditional methods used to assess kidney function, like serum creatinine or estimated glomerular filtration rate. Moreover, the list of potential AKI markers tested in HSCT conditions is limited and does not involve indexes evaluated in the pediatric population. This review summarizes current knowledge on the pathophysiology of AKI developing in the course of HSCT; presents well-known markers of AKI that are potentially applicable in children who have undergone HSCT; discusses the role of new markers in diagnosing AKI and predicting the renal outcome in children undergoing HSCT; and analyzes the prospects for the use of new tools for assessing kidney injury in everyday clinical practice.

摘要

急性肾损伤(AKI)是造血干细胞移植(HSCT)患儿的主要并发症之一,是患者生存的独立预测因子,也是进展为慢性肾脏病(CKD)的预后因素。尽管 AKI 具有多方面的作用,但在 HSCT 过程中对其进行早期诊断仍然具有挑战性。这些困难可能源于传统的肾功能评估方法(如血清肌酐或估计肾小球滤过率)的效率低下。此外,在 HSCT 条件下测试的潜在 AKI 标志物的清单有限,并且不包括在儿科人群中评估的指标。本综述总结了 HSCT 过程中发生 AKI 的病理生理学的现有知识;介绍了在接受 HSCT 的儿童中潜在适用的 AKI 的已知标志物;讨论了新标志物在诊断 AKI 和预测儿童 HSCT 肾脏结局中的作用;并分析了在日常临床实践中使用新工具评估肾损伤的前景。

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