Department of Nephrology and Kidney Transplantation, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France.
Human Immunology and Immunopathology, Inserm UMR 976, Université Paris Cité, 75010 Paris, France.
Biomolecules. 2024 Jan 8;14(1):82. doi: 10.3390/biom14010082.
Acute kidney injury (AKI) remains a complex challenge with diverse underlying pathological mechanisms and etiologies. Current detection methods predominantly rely on serum creatinine, which exhibits substantial limitations in specificity and poses the issue of late-stage detection of kidney injury. In this review, we propose an up-to-date and comprehensive summary of advancements that identified novel biomarker candidates in blood and urine and ideal criteria for AKI biomarkers such as renal injury specificity, mechanistic insight, prognostic capacity, and affordability. Recently identified biomarkers not only indicate injury location but also offer valuable insights into a range of pathological processes, encompassing reduced glomerular filtration rate, tubular function, inflammation, and adaptive response to injury. The clinical applications of AKI biomarkers are becoming extensive and serving as relevant tools in distinguishing acute tubular necrosis from other acute renal conditions. Also, these biomarkers can offer significant insights into the risk of progression to chronic kidney disease CKD and in the context of kidney transplantation. Integration of these biomarkers into clinical practice has the potential to improve early diagnosis of AKI and revolutionize the design of clinical trials, offering valuable endpoints for therapeutic interventions and enhancing patient care and outcomes.
急性肾损伤 (AKI) 仍然是一个具有多种潜在病理机制和病因的复杂挑战。目前的检测方法主要依赖于血清肌酐，其特异性存在很大局限性，并且存在肾脏损伤晚期检测的问题。在这篇综述中，我们提出了一个最新和全面的总结，确定了血液和尿液中新型生物标志物候选物，以及 AKI 生物标志物的理想标准，如肾脏损伤特异性、机制洞察力、预后能力和可负担性。最近确定的生物标志物不仅表明了损伤部位，还提供了对一系列病理过程的有价值的见解，包括肾小球滤过率降低、肾小管功能、炎症和对损伤的适应性反应。AKI 生物标志物的临床应用正在变得广泛，并作为区分急性肾小管坏死与其他急性肾损伤的相关工具。此外，这些生物标志物还可以深入了解进展为慢性肾脏病 (CKD) 的风险，以及在肾移植的背景下。将这些生物标志物整合到临床实践中有可能改善 AKI 的早期诊断，并彻底改变临床试验的设计，为治疗干预提供有价值的终点，并改善患者的护理和结果。
