评估急性肾损伤中肾单位的健康状况：肾功能和损伤的生物标志物。
Assessing the health of the nephron in acute kidney injury: biomarkers of kidney function and injury.
机构信息
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
Curr Opin Nephrol Hypertens. 2019 Nov;28(6):560-566. doi: 10.1097/MNH.0000000000000538.
Abstract
PURPOSE OF REVIEW
Serum creatinine and urine output continue to be the mainstays of diagnosis of acute kidney injury, though both of these measures have significant limitations, especially in acutely hospitalized patients. Biomarkers in both blood and urine have been studied extensively in the research setting and are on the verge of clinical practice to improve diagnosis of AKI.
RECENT FINDINGS
Blood and urine biomarkers can be localized to specific areas or functions within the nephron. Biomarkers can help to characterize glomerular or tubular function; glomerular, tubular, or interstitial injury; inflammation; or repair. Further, biomarkers can improve diagnosis of AKI in various clinical settings including acute interstitial nephritis, acute tubular injury, and hepatorenal syndrome, and cardiorenal syndrome.
SUMMARY
Biomarkers are becoming more prevalent in both research and getting close to clinical use. Both blood and urine biomarkers can help to localize impairment in nephron health by either location or function within the nephron and among various causes of AKI.
摘要
目的综述
血清肌酐和尿量仍是急性肾损伤诊断的主要依据，但这两种方法都有明显的局限性，尤其是在急性住院患者中。血液和尿液中的生物标志物在研究中已得到广泛研究，并且即将在临床上应用于改善 AKI 的诊断。
最近的发现
血液和尿液生物标志物可定位于肾单位内的特定区域或功能。生物标志物可以帮助表征肾小球或肾小管功能；肾小球、肾小管或间质性损伤；炎症；或修复。此外，生物标志物可改善急性间质性肾炎、急性肾小管损伤和肝肾综合征以及心肾综合征等各种临床情况下 AKI 的诊断。
总结
生物标志物在研究和临床应用中越来越普遍。血液和尿液生物标志物都可以通过位置或肾单位内的功能以及 AKI 的各种原因来帮助定位肾单位健康受损。
相似文献
1
Assessing the health of the nephron in acute kidney injury: biomarkers of kidney function and injury.评估急性肾损伤中肾单位的健康状况：肾功能和损伤的生物标志物。
Curr Opin Nephrol Hypertens. 2019 Nov;28(6):560-566. doi: 10.1097/MNH.0000000000000538.
2
Urinary Biomarkers and Kidney Injury in VA NEPHRON-D: Phenotyping Acute Kidney Injury in Clinical Trials.VA NEPHRON-D 中的尿生物标志物与肾损伤：临床试验中急性肾损伤的表型研究。
Am J Kidney Dis. 2024 Feb;83(2):151-161. doi: 10.1053/j.ajkd.2023.07.012. Epub 2023 Sep 17.
3
Current concepts and advances in biomarkers of acute kidney injury.急性肾损伤生物标志物的当前概念和进展。
Crit Rev Clin Lab Sci. 2021 Aug;58(5):354-368. doi: 10.1080/10408363.2021.1879000. Epub 2021 Feb 8.
4
Biomarkers of renal function, which and when?肾功能的生物标志物，哪些以及何时（检测）？
Clin Chim Acta. 2015 Jan 1;438:350-7. doi: 10.1016/j.cca.2014.08.039. Epub 2014 Sep 3.
5
Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N-acetyl-β-D-glucosaminidase.血清胱抑素 C 和尿 N-乙酰-β-D-氨基葡萄糖苷酶评估和预测失代偿期肝硬化患者的急性肾损伤。
J Gastroenterol Hepatol. 2019 Jan;34(1):234-240. doi: 10.1111/jgh.14387. Epub 2018 Aug 21.
6
Urinary interleukin-18 and urinary neutrophil gelatinase-associated lipocalin predict acute kidney injury following pulmonary valve replacement prior to serum creatinine.尿白细胞介素-18和尿中性粒细胞明胶酶相关脂质运载蛋白在血清肌酐升高之前就能预测肺动脉瓣置换术后的急性肾损伤。
Congenit Heart Dis. 2012 Sep-Oct;7(5):441-7. doi: 10.1111/j.1747-0803.2012.00662.x. Epub 2012 Apr 27.
7
Advances and Challenges on New Therapies and Clinical Targets of Acute Kidney Injury.急性肾损伤新疗法与临床靶点的进展与挑战
Toxicol Pathol. 2018 Dec;46(8):925-929. doi: 10.1177/0192623318800688. Epub 2018 Oct 3.
8
Mechanism-specific injury biomarkers predict nephrotoxicity early following glyphosate surfactant herbicide (GPSH) poisoning.机制特异性损伤生物标志物可在草甘膦表面活性剂除草剂（GPSH）中毒后早期预测肾毒性。
Toxicol Lett. 2016 Sep 6;258:1-10. doi: 10.1016/j.toxlet.2016.06.001. Epub 2016 Jun 7.
9
Performance of Serum Creatinine and Kidney Injury Biomarkers for Diagnosing Histologic Acute Tubular Injury.血清肌酐和肾损伤生物标志物在诊断组织学急性肾小管损伤中的表现
Am J Kidney Dis. 2017 Dec;70(6):807-816. doi: 10.1053/j.ajkd.2017.06.031. Epub 2017 Aug 24.
10
Acute Kidney Injury: Diagnosis and Classification in Adults and Children.急性肾损伤：成人及儿童的诊断与分类
Contrib Nephrol. 2018;193:1-12. doi: 10.1159/000484956. Epub 2018 Jan 23.
引用本文的文献
1
[Early identification of acute kidney injury in children with primary nephrotic syndrome].[原发性肾病综合征患儿急性肾损伤的早期识别]
Zhongguo Dang Dai Er Ke Za Zhi. 2024;26(9):921-925. doi: 10.7499/j.issn.1008-8830.2405033.
2
Urinary Collectrin as Promising Biomarker for Acute Kidney Injury in Patients Undergoing Cardiac Surgery.尿Collectrin作为心脏手术患者急性肾损伤的潜在生物标志物
Biomedicines. 2023 Dec 7;11(12):3244. doi: 10.3390/biomedicines11123244.
3
Urinary Biomarkers and Kidney Injury in VA NEPHRON-D: Phenotyping Acute Kidney Injury in Clinical Trials.VA NEPHRON-D 中的尿生物标志物与肾损伤：临床试验中急性肾损伤的表型研究。
Am J Kidney Dis. 2024 Feb;83(2):151-161. doi: 10.1053/j.ajkd.2023.07.012. Epub 2023 Sep 17.
4
Evaluation of Plasma Biomarkers to Predict Major Adverse Kidney Events in Hospitalized Patients With COVID-19.评估血浆生物标志物对 COVID-19 住院患者主要不良肾脏事件的预测作用。
Am J Kidney Dis. 2023 Sep;82(3):322-332.e1. doi: 10.1053/j.ajkd.2023.03.010. Epub 2023 May 30.
5
Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers.根据病史和生化标准识别肾前性和内在急性肾损伤：与尿损伤生物标志物的明确关联。
Int J Mol Sci. 2023 Jan 17;24(3):1826. doi: 10.3390/ijms24031826.
6
New Biomarkers in Early Diagnosis of Acute Kidney Injury in Children.儿童急性肾损伤早期诊断中的新生物标志物
Avicenna J Med Biotechnol. 2022 Oct-Dec;14(4):264-269.
7
Astragaloside IV protects against ischemia/reperfusion (I/R)-induced kidney injury based on the Keap1-Nrf2/ARE signaling pathway.黄芪甲苷基于Keap1-Nrf2/ARE信号通路对缺血/再灌注（I/R）诱导的肾损伤具有保护作用。
Transl Androl Urol. 2022 Aug;11(8):1177-1188. doi: 10.21037/tau-22-505.
8
Metabolic mechanisms of acute proximal tubular injury.急性近端肾小管损伤的代谢机制。
Pflugers Arch. 2022 Aug;474(8):813-827. doi: 10.1007/s00424-022-02701-y. Epub 2022 May 14.
9
The Role of RIPC in Preventing Organ Damage, Inflammation, and Oxidative Stress during Lower Limb DSA: A Randomised Controlled Trial.远程缺血预处理在预防下肢 DSA 中器官损伤、炎症和氧化应激中的作用：一项随机对照试验。
Oxid Med Cell Longev. 2021 Dec 8;2021:6043550. doi: 10.1155/2021/6043550. eCollection 2021.
10
Drug toxicity in the proximal tubule: new models, methods and mechanisms.药物性近端肾小管损伤：新型模型、方法和机制。
Pediatr Nephrol. 2022 May;37(5):973-982. doi: 10.1007/s00467-021-05121-9. Epub 2021 May 28.
本文引用的文献
1
Urine TNF-α and IL-9 for clinical diagnosis of acute interstitial nephritis.尿液 TNF-α 和 IL-9 用于急性间质性肾炎的临床诊断。
JCI Insight. 2019 May 16;4(10). doi: 10.1172/jci.insight.127456.
2
Predicting Cardiac Surgery-Associated Acute Kidney Injury Using a Combination of Clinical Risk Scores and Urinary Biomarkers.使用临床风险评分和尿液生物标志物组合预测心脏手术相关急性肾损伤
Thorac Cardiovasc Surg. 2020 Aug;68(5):389-400. doi: 10.1055/s-0039-1678565. Epub 2019 Feb 11.
3
Uromodulin (Tamm-Horsfall protein): guardian of urinary and systemic homeostasis.尿调蛋白（Tamm-Horsfall 蛋白）：守护尿内和全身内环境稳定的蛋白。
Nephrol Dial Transplant. 2020 Jan 1;35(1):33-43. doi: 10.1093/ndt/gfy394.
4
Mechanisms Underlying Increased TIMP2 and IGFBP7 Urinary Excretion in Experimental AKI.实验性 AKI 中 TIMP2 和 IGFBP7 尿排泄增加的机制。
J Am Soc Nephrol. 2018 Aug;29(8):2157-2167. doi: 10.1681/ASN.2018030265. Epub 2018 Jul 6.
5
Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies.急性肾损伤：流行病学、预后、并发症及治疗策略。
Semin Dial. 2018 Sep;31(5):519-527. doi: 10.1111/sdi.12705. Epub 2018 May 8.
6
Biomarker definitions and their applications.生物标志物的定义及其应用。
Exp Biol Med (Maywood). 2018 Feb;243(3):213-221. doi: 10.1177/1535370217750088.
7
Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury.在接受积极利尿治疗的急性心力衰竭患者中，肾功能恶化与肾小管损伤无关。
Circulation. 2018 May 8;137(19):2016-2028. doi: 10.1161/CIRCULATIONAHA.117.030112. Epub 2018 Jan 19.
8
Preoperative levels of urinary uromodulin predict acute kidney injury after pediatric cardiopulmonary bypass surgery.尿尿调蛋白术前水平可预测小儿体外循环心脏手术后急性肾损伤。
Pediatr Nephrol. 2018 Mar;33(3):521-526. doi: 10.1007/s00467-017-3823-0. Epub 2017 Oct 23.
9
Performance of Serum Creatinine and Kidney Injury Biomarkers for Diagnosing Histologic Acute Tubular Injury.血清肌酐和肾损伤生物标志物在诊断组织学急性肾小管损伤中的表现
Am J Kidney Dis. 2017 Dec;70(6):807-816. doi: 10.1053/j.ajkd.2017.06.031. Epub 2017 Aug 24.
10
Relationship of Kidney Injury Biomarkers with Long-Term Cardiovascular Outcomes after Cardiac Surgery.心脏手术后肾损伤生物标志物与长期心血管结局的关系
J Am Soc Nephrol. 2017 Dec;28(12):3699-3707. doi: 10.1681/ASN.2017010055. Epub 2017 Aug 14.
Zotero 插件