Challenges and Advances in the Treatment of AKI
Challenges and Advances in the Treatment of AKI
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DOI：
10.1681/asn.2013070780
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发表时间：
2014-05-01
影响因子：
13.6
通讯作者：
Shah, Sudhir V.
中科院分区：
文献类型：
--
作者：
Kaushal, Gur P.;Shah, Sudhir V.
治疗或预防阿基需要治疗或预防血清肌酐升高以及与阿基相关的即刻和远期临床后果。由于大量阿基患者进展为ESRD，因此识别可能进展的患者并阻止进展是治疗阿基的重要目标。目前正在开发许多针对阿基的疗法，包括RenalGuard疗法，其目的是维持高尿量; -促黑素细胞激素，具有抗炎和抗凋亡活性;碱性磷酸酶，其使促炎物质解毒;新型小干扰RNA，针对p53激活; THR-184，骨形态发生蛋白的肽激动剂;去除催化铁，这在自由基形成中很重要;以及基于细胞的疗法，包括体内间充质干细胞和原位肾细胞疗法。在这篇综述中，我们探讨了阿基治疗的真正含义，讨论了新兴的治疗方法，并研究了治疗阿基的机会之窗。最后，我们提供了加速预防和治疗阿基的建议，例如建立阿基网络，实施催化慈善模式，并将一小部分Medicare ESRD预算用于开发预防和治疗阿基并阻止CKD进展的疗法。
Treating or preventing AKI requires treating or preventing a rise in serum creatinine as well as the immediate and remote clinical consequences associated with AKI. Because a substantial number of patients with AKI progress to ESRD, identifying patients likely to progress and halting progression are important goals for treating AKI. Many therapies for AKI are being developed, including RenalGuard Therapy, which aims to maintain high urine output; -melanocyte-stimulating hormone, with anti-inflammatory and antiapoptotic activities; alkaline phosphatase, which detoxifies proinflammatory substances; novel, small interfering RNA, directed at p53 activation; THR-184, a peptide agonist of bone morphogenetic proteins; removal of catalytic iron, important in free-radical formation; and cell-based therapies, including mesenchymal stem cells in vivo and renal cell therapy in situ. In this review, we explore what treatment of AKI really means, discuss the emerging therapies, and examine the windows of opportunity for treating AKI. Finally, we provide suggestions for accelerating the pathways toward preventing and treating AKI, such as establishing an AKI network, implementing models of catalytic philanthropy, and directing a small percentage of the Medicare ESRD budget for developing therapies to prevent and treat AKI and halt progression of CKD.