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肾纤维化的非侵入性诊断进展

Advancements in the non-invasive diagnosis of renal fibrosis.

作者信息

Yuan Tingting, Wang Hong, Kang Ting, Wu Weihua, Ou Santao

机构信息

Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.

Sichuan Clinical Research Center for Nephrology, Luzhou, China.

出版信息

Front Med (Lausanne). 2025 Jul 30;12:1646412. doi: 10.3389/fmed.2025.1646412. eCollection 2025.


DOI:10.3389/fmed.2025.1646412
PMID:40809416
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12343605/
Abstract

Renal fibrosis is the central pathological pathway by which various primary and secondary kidney diseases progress to end-stage renal disease. It is characterized by excessive extracellular matrix deposition and destruction of the native renal parenchyma, ultimately leading to irreversible loss of nephrons. Currently, percutaneous renal biopsy with histopathological evaluation remains the diagnostic gold standard for renal fibrosis, allowing semiquantitative scoring of renal interstitial fibrosis and glomerulosclerosis (e.g., Banff grading). However, this invasive procedure carries a risk of bleeding and is limited by sampling error and inter-observer variability, making it impractical for dynamic disease monitoring. In recent years, significant advances have been made in noninvasive diagnostic techniques. These include: (1) blood and urine biomarkers such as markers of ECM metabolism, inflammatory factors, tubular injury markers, and extracellular vesicles; (2) imaging modalities including novel ultrasound techniques, shear wave elastography, functional magnetic resonance imaging (MRI) methods such as diffusion-weighted imaging, blood oxygen level-dependent MRI, magnetic resonance elastography, and positron emission tomography/computed tomography using radiotracers targeting fibrosis-associated molecules such as Ga-FAPI. This review systematically summarizes the latest evidence on the above biomarkers and advanced imaging modalities, with an emphasis on their diagnostic performance (sensitivity/specificity), utility for dynamic monitoring, and bottlenecks in clinical translation. The aim is to develop a multimodal, noninvasive assessment system to enable earlier fibrosis detection, stratified disease management, and precise intervention targeting fibrogenic pathways, ultimately improving renal disease outcomes.

摘要

肾纤维化是各种原发性和继发性肾脏疾病进展至终末期肾病的核心病理途径。其特征是细胞外基质过度沉积和天然肾实质破坏,最终导致肾单位不可逆转的丧失。目前,经皮肾活检及组织病理学评估仍是肾纤维化的诊断金标准,可对肾间质纤维化和肾小球硬化进行半定量评分(如Banff分级)。然而,这种侵入性操作存在出血风险,且受抽样误差和观察者间差异的限制,使其不适用于疾病的动态监测。近年来,非侵入性诊断技术取得了重大进展。这些技术包括:(1)血液和尿液生物标志物,如细胞外基质代谢标志物、炎症因子、肾小管损伤标志物和细胞外囊泡;(2)成像方式,包括新型超声技术、剪切波弹性成像、功能磁共振成像(MRI)方法,如扩散加权成像、血氧水平依赖性功能磁共振成像、磁共振弹性成像,以及使用靶向纤维化相关分子(如镓标记的成纤维细胞激活蛋白抑制剂(Ga-FAPI))的放射性示踪剂的正电子发射断层扫描/计算机断层扫描。本综述系统总结了上述生物标志物和先进成像方式的最新证据,重点关注其诊断性能(敏感性/特异性)、动态监测的实用性以及临床转化中的瓶颈。目的是开发一种多模式、非侵入性评估系统,以实现更早的纤维化检测、分层疾病管理以及针对纤维化途径的精准干预,最终改善肾脏疾病的治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/310c3512304f/fmed-12-1646412-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/b7db15a31947/fmed-12-1646412-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/54e9f9f58954/fmed-12-1646412-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/310c3512304f/fmed-12-1646412-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/b7db15a31947/fmed-12-1646412-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/54e9f9f58954/fmed-12-1646412-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ef9/12343605/310c3512304f/fmed-12-1646412-g003.jpg

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本文引用的文献

[1]
Advanced ultrasound methods to improve chronic kidney disease diagnosis.

Npj Imaging. 2024-7-25

[2]
Trimethylamine--oxide formation, the bacterial taxa involved and intervention strategies to reduce its concentration in the human body.

Ann Med. 2025-12

[3]
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Bioengineering (Basel). 2025-4-25

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Mol Nutr Food Res. 2025-7

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Mil Med Res. 2025-4-27

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BMJ Health Care Inform. 2025-3-17

[10]
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Adv Sci (Weinh). 2025-6

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