Division of Nephrology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
Department of Computational Medicine and Bioinformatics, Michigan Medicine, Ann Arbor, MI, USA.
Nat Rev Nephrol. 2020 Nov;16(11):657-668. doi: 10.1038/s41581-020-0286-5. Epub 2020 May 18.
Chronic kidney diseases (CKDs) are currently classified according to their clinical features, associated comorbidities and pattern of injury on biopsy. Even within a given classification, considerable variation exists in disease presentation, progression and response to therapy, highlighting heterogeneity in the underlying biological mechanisms. As a result, patients and clinicians experience uncertainty when considering optimal treatment approaches and risk projection. Technological advances now enable large-scale datasets, including DNA and RNA sequence data, proteomics and metabolomics data, to be captured from individuals and groups of patients along the genotype-phenotype continuum of CKD. The ability to combine these high-dimensional datasets, in which the number of variables exceeds the number of clinical outcome observations, using computational approaches such as machine learning, provides an opportunity to re-classify patients into molecularly defined subgroups that better reflect underlying disease mechanisms. Patients with CKD are uniquely poised to benefit from these integrative, multi-omics approaches since the kidney biopsy, blood and urine samples used to generate these different types of molecular data are frequently obtained during routine clinical care. The ultimate goal of developing an integrated molecular classification is to improve diagnostic classification, risk stratification and assignment of molecular, disease-specific therapies to improve the care of patients with CKD.
慢性肾脏病(CKD)目前根据其临床特征、相关合并症和活检中的损伤模式进行分类。即使在给定的分类中,疾病的表现、进展和对治疗的反应也存在很大差异,这突显了潜在生物学机制的异质性。因此,患者和临床医生在考虑最佳治疗方法和风险预测时会感到不确定。技术进步现在使包括 DNA 和 RNA 序列数据、蛋白质组学和代谢组学数据在内的大规模数据集能够从 CKD 基因型-表型连续体中的个体和患者群体中捕获。使用机器学习等计算方法,将这些高维数据集(其中变量数量超过临床结果观察数量)进行组合,为重新将患者分类为分子定义的亚组提供了机会,这些亚组更好地反映了潜在的疾病机制。CKD 患者特别适合从这些综合的多组学方法中受益,因为生成这些不同类型分子数据的肾活检、血液和尿液样本通常是在常规临床护理中获得的。开发综合分子分类的最终目标是改善诊断分类、风险分层以及分配针对特定疾病的分子治疗,以改善 CKD 患者的护理。