Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Curr Opin Crit Care. 2020 Dec;26(6):549-555. doi: 10.1097/MCC.0000000000000770.
Acute kidney injury (AKI) is common and associated with high patient mortality, and accelerated progression to chronic kidney disease. Our ability to diagnose and stratify patients with AKI is paramount for translational progress. Unfortunately, currently available methods have major pitfalls. Serum creatinine is an insensitive functional biomarker of AKI, slow to register the event and influenced by multiple variables. Cystatin C, a proposed alternative, requires long laboratory processing and also lacks specificity. Other techniques are either very cumbersome (inuline, iohexol) or involve administration of radioactive products, and are therefore, not applicable on a large scale.
The development of two optical measurement techniques utilizing novel minimally invasive techniques to quantify kidney function, independent of serum or urinary measurements is advancing. Utilization of both one and two compartmental models, as well as continuous monitoring, are being developed.
The clinical utility of rapid GFR measurements in AKI patients remains unknown as these disruptive technologies have not been tested in studies exploring clinical outcomes. However, these approaches have the potential to improve our understanding of AKI and clinical care. This overdue technology has the potential to individualize patient care and foster therapeutic success in AKI.
急性肾损伤（AKI）较为常见，与患者死亡率高和加速进展为慢性肾脏病相关。我们诊断和分层 AKI 患者的能力对转化研究至关重要。遗憾的是，目前可用的方法存在重大缺陷。血清肌酐是 AKI 的一种不敏感的功能生物标志物，对该事件的反应较慢，并且受到多种变量的影响。胱抑素 C 是一种替代方法，但需要较长的实验室处理时间，并且特异性也不足。其他技术要么非常繁琐（菊粉、碘海醇），要么涉及放射性产品的给药，因此无法大规模应用。
利用新型微创技术，开发了两种光学测量技术来定量肾功能，不依赖于血清或尿液测量，这一技术正在不断发展。正在开发单室和双室模型以及连续监测。
快速 GFR 测量在 AKI 患者中的临床应用尚不清楚，因为这些突破性技术尚未在探索临床结局的研究中进行测试。然而，这些方法有可能改善我们对 AKI 的认识和临床护理。这项姗姗来迟的技术有可能实现个体化患者护理，并促进 AKI 的治疗成功。
