Differential Diagnosis of AKI in Clinical Practice by Functional and Damage Biomarkers: Workgroup Statements from the Tenth Acute Dialysis Quality Initiative Consensus Conference
Differential Diagnosis of AKI in Clinical Practice by Functional and Damage Biomarkers: Workgroup Statements from the Tenth Acute Dialysis Quality Initiative Consensus Conference
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DOI：
10.1159/000349964
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发表时间：
2013-01-01
期刊：
影响因子：
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通讯作者：
Murray, Patrick T.
中科院分区：
文献类型：
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作者：
Endre, Zoltan H.;Kellum, John A.;Murray, Patrick T.
急性肾损伤（阿基）是一种常见但复杂的临床综合征，具有多种病因。这些病因靶向肾脏内的不同部位和途径。新的“肾损伤”生物标志物（可以是肾小管或肾小球）可用于诊断阿基，即使在血清肌酐或少尿不增加的情况下。这些肾损伤的生物标志物可以与肾功能的生物标志物组合以促进阿基的分类。使用急性透析质量倡议（ADQI）工作组发表的方法对文献进行了全面审查，并用于建立关于阿基鉴别诊断中使用生物标志物的共识声明。我们建议优先使用病理生理学术语“功能改变”和“肾损伤”，而不是使用术语肾前、肾和肾后阿基的解剖学分类。我们进一步建议在诊断后尽快使用肾脏和非肾脏生物标志物来确定阿基的具体原因。基础CKD或脓毒症的存在对鉴别诊断提出了额外的挑战，因为这些疾病改变了基线生物标志物排泄和生物标志物性能。我们建议生物标志物在其使用的临床背景下进行验证。在这种情况下，生物标志物的组合可能在未来允许区分损伤的部位、机制和阶段。版权所有（C）2013 S. Karger AG，巴塞尔
Acute kidney injury (AKI) is a common but complex clinical syndrome with multiple etiologies. These etiologies target different sites and pathways within the kidney. Novel biomarkers of 'kidney damage' (which can be tubular or glomerular) can be used to diagnose AKI, even in the absence of an increase in serum creatinine or oliguria. These biomarkers of kidney damage can be combined with biomarkers of kidney function to facilitate classification of AKI. A comprehensive review of the literature was performed using the published methodology of the Acute Dialysis Quality Initiative (ADQI) working group and used to establish consensus statements regarding the use of biomarkers in the differential diagnosis of AKI. We recommend that the pathophysiological terms 'functional change' and 'kidney damage' be used in preference to the anatomical classification using the terms pre-renal, renal and post-renal AKI. We further recommend the use of both renal and non-renal biomarkers in establishing the specific cause of AKI as soon as possible after diagnosis. The presence of underlying CKD or of sepsis poses additional challenges in differential diagnosis, since these conditions alter both baseline biomarker excretion and biomarker performance. We recommend that biomarkers be validated within the clinical context in which they are to be used. Within that context, combinations of biomarkers may, in the future, allow differentiation of the site, mechanism and phase of injury. Copyright (C) 2013 S. Karger AG, Basel