Clinic of Nephrology, University Hospital Zurich.
Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Curr Opin Nephrol Hypertens. 2024 Jan 1;33(1):130-135. doi: 10.1097/MNH.0000000000000930. Epub 2023 Sep 15.
The aim of this review is to discuss the concept of renal functional reserve (RFR) and its potential relevance in clinical practice.
The RFR is a measure of the change in glomerular filtration rate (GFR) from baseline to a peak value when the kidney is stimulated to increase its function. This concept has a strong physiologic basis in nephrology and the presence, magnitude or absence of RFR capacity may have prognostic significance in many clinical scenarios where individuals are at risk of hyperfiltration or kidney dysfunction. Unlike in other medical specialties, where organ reserve function is reliably measurable and used routinely, measurement of RFR in nephrology has not been integrated into clinical care. Methodologic challenges including standardization of methods to stimulate GFR and the ability of measures of GFR to discriminate acute dynamic changes in GFR upon kidney stimulation have hampered the robustness and use of RFR measurements in research and clinical care.
Given the emergence of many new disease-modifying therapies in nephrology, it is imperative that we move forward and develop more robust tools to further our understanding of kidney physiology and pathophysiology, such as the RFR, which should be integrated into research and clinical care to support optimal personalization of therapeutic kidney care strategies.
本文旨在讨论肾脏功能储备（RFR）的概念及其在临床实践中的潜在相关性。
RFR 是衡量肾脏刺激后肾小球滤过率（GFR）从基线到峰值变化的指标。这一概念在肾脏病学中有很强的生理学基础，在许多个体存在高滤过或肾功能障碍风险的临床情况下，RFR 能力的存在、程度或缺失可能具有预后意义。与其他医学专业不同，器官储备功能可以可靠地测量并常规使用，而肾脏病学中的 RFR 测量尚未纳入临床护理。方法学挑战，包括刺激 GFR 的方法标准化以及 GFR 测量区分肾脏刺激时 GFR 急性动态变化的能力，阻碍了 RFR 测量在研究和临床护理中的稳健性和应用。
鉴于肾脏病学中出现了许多新的疾病修饰治疗方法，我们必须向前迈进，开发更强大的工具来进一步了解肾脏生理学和病理生理学，例如 RFR，它应该整合到研究和临床护理中，以支持治疗性肾脏护理策略的最佳个体化。
