Royal Veterinary College, North Mymms, Herts, AL9 7TA, UK.
J Small Anim Pract. 2021 Feb;62(2):71-81. doi: 10.1111/jsap.13236. Epub 2020 Nov 13.
Within clinical small animal practice, diagnosis of both chronic kidney disease and acute kidney injury is common. To assess renal function, measurement of glomerular filtration rate is considered the gold standard. Currently, routine tests of kidney function include surrogate markers of glomerular filtration rate such as serum creatinine, and urea, each with their own limitations, whilst urine protein to creatinine ratio gives an indication of glomerular and tubular handling of protein, and urine specific gravity information about urine concentrating ability by the kidney. These parameters are used together with historical and physical examination data to give a diagnosis of kidney disease following which creatinine, proteinuria and blood pressure are used to stage chronic kidney disease and, together with urine output, grade acute kidney injury according to the International Renal Interest Society. However, there has been much concern that creatinine is insensitive when used to indicate early decline in renal function and this has highlighted the need for additional methods of diagnosing and monitoring these patients, with the potential to allow earlier therapeutic intervention. Symmetric dimethylarginine is a novel biomarker, which has been shown to perform as a surrogate marker of glomerular filtration rate in small animals. This article will review current research on symmetric dimethylarginine and the ways in which it may be utilised in small animal practice; current research supports the use of symmetric dimethylarginine as a screening test for detection of early chronic kidney disease according to International Renal Interest Society guidelines, but further research is required in to the usefulness of symmetric dimethylarginine as a tool for monitoring disease and the effect of non-renal influences.
在临床小动物医学中，慢性肾脏病和急性肾损伤的诊断都很常见。为了评估肾功能，肾小球滤过率的测量被认为是金标准。目前，肾功能的常规检测包括血清肌酐和尿素等肾小球滤过率的替代标志物，每种标志物都有其自身的局限性，而尿蛋白与肌酐比值则反映了肾小球和肾小管对蛋白质的处理情况，尿比重则反映了肾脏浓缩尿液的能力。这些参数与病史和体格检查数据一起，用于诊断肾脏病，然后根据国际肾脏病学会的标准，使用肌酐、蛋白尿和血压对慢性肾脏病进行分期，并根据尿输出量对急性肾损伤进行分级。然而，人们一直担心肌酐在指示肾功能早期下降时不够敏感，这突出表明需要额外的方法来诊断和监测这些患者，以便更早地进行治疗干预。对称二甲基精氨酸是一种新型生物标志物，已被证明可作为小动物肾小球滤过率的替代标志物。本文将回顾对称二甲基精氨酸的当前研究及其在小动物医学中的应用方式；目前的研究支持将对称二甲基精氨酸作为根据国际肾脏病学会指南检测早期慢性肾脏病的筛查试验，但还需要进一步研究对称二甲基精氨酸作为监测疾病和非肾脏影响的工具的有用性。
