Sub-Phenotypes of Acute Kidney Injury: Do We Have Progress for Personalizing Care?
Sub-Phenotypes of Acute Kidney Injury: Do We Have Progress for Personalizing Care?
复制标题
作者：
Thau MR;Bhatraju PK
急性肾损伤（阿基）是重症监护室（ICU）患者中最常见的器官功能障碍形式，并显著导致长期预后不良。尽管存在这种公共卫生影响，但阿基尚无有效的药物治疗。一个原因可能是目前定义的阿基中存在异质性，从而隐藏了特定于某些阿基人群的独特病理生理过程。支持这一观点，我们和其他人已经表明，阿基临床综合征存在多样性，目前诊断指南的“一刀切”方法可能并不理想。利用个体的遗传、生物学和临床特征来识别阿基亚表型的“精确医学”方法可以克服这些限制。阿基亚表型的鉴定可以通过以下方式解决阿基中关键的未满足的临床需求：1）改善风险预测，2）鉴定新的病理生理学，以及3）告知患者响应当前治疗剂或建立新的治疗靶点以预防和治疗阿基的可能性。本文综述了阿基表型的现状和未来的发展方向。
Acute kidney injury (AKI) is the most common form of organ dysfunction occurring in patients admitted to the intensive care unit (ICU) and contributes significantly to poor long-term outcomes. Despite this public health impact, no effective pharmacotherapy exists for AKI. One reason may be that heterogeneity is present within AKI as currently defined, thereby concealing unique pathophysiologic processes specific to certain AKI populations. Supporting this notion, we and others have shown that diversity within the AKI clinical syndrome exists and the ‘one size fits all’ approach by current diagnostic guidelines may not be ideal. A ‘precision medicine’ approach that exploits an individual’s genetic, biologic and clinical characteristics to identify AKI sub-phenotypes may overcome such limitations. Identification of AKI sub-phenotypes may address a critical unmet clinical need in AKI by 1) improving risk prognostication, 2) identifying novel pathophysiology and 3) informing a patient’s likelihood of responding to current therapeutics or establishing new therapeutic targets to prevent and treat AKI. This review discusses the current state of phenotyping AKI and future directions.
登录
查看更多内容
影响因子：
15.1
作者：
Bhatraju, Pavan K.;Mukherjee, Paramita;Wurfel, Mark M.
通讯作者：
Wurfel, Mark M.
影响因子：
13.8
作者：
Bhatraju, Pavan K.;Zelnick, Leila R.;Wurfel, Mark M.
通讯作者：
Wurfel, Mark M.
影响因子：
13.6
作者：
Koyner, Jay L.;Davison, Danielle L.;Chawla, Lakhmir S.
通讯作者：
Chawla, Lakhmir S.
影响因子：
19.6
作者：
通讯作者：
--
DOI：
10.1164/rccm.201807-1346oc
发表时间：
2019-04-01
影响因子：
24.7
作者：
Bhatraju, Pavan K.;Zelnick, Leila R.;Wurfel, Mark M.
通讯作者：
Wurfel, Mark M.