What is new in uremic toxicity?
What is new in uremic toxicity?
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DOI：
10.1007/s00467-008-0762-9
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发表时间：
2008-08
影响因子：
3
通讯作者：
Glorieux, Griet
中科院分区：
文献类型：
--
作者：
Vanholder, Raymond;Van Laecke, Steven;Glorieux, Griet
关键词：
尿毒症综合征是由于化合物滞留引起的各种器官系统的故障所致，在正常情况下，这些化合物会被排入尿液和/或由肾脏代谢。如果这些化合物具有生物活性，它们就被称为尿毒症毒素。这类化合物的一个更重要的毒性作用是心血管损伤。根据影响透析法去除这类化合物的物理化学特征，一种方便的分类是：(1)小的水溶性化合物；(2)蛋白质结合的化合物；(3)较大的“中间分子”。最近的进展包括鉴定几种新发现的与毒性有关的化合物或鉴定已知化合物的未知毒性作用：二核苷酸多磷酸、血管紧张素II的结构变体、白细胞介素18、对甲酚硫酸盐和鸟嘌呤类化合物。毒性效应似乎通常是由“很难通过透析去除”的分子产生的。因此，透析策略被采用了具有更大孔径的膜(高通量膜)和/或对流(在线血液透析过滤)。最近的研究结果表明，这些策略有更好的结果，从而在临床上证实了在BASE研究中归因于这些“难以去除的”分子的重要性。
Uremic syndrome results from a malfunctioning of various organ systems due to the retention of compounds which, under normal conditions, would be excreted into the urine and/or metabolized by the kidneys. If these compounds are biologically active, they are called uremic toxins. One of the more important toxic effects of such compounds is cardio-vascular damage. A convenient classification based on the physico-chemical characteristics affecting the removal of such compounds by dialysis is: (1) small water-soluble compounds; (2) protein-bound compounds; (3) the larger “middle molecules”. Recent developments include the identification of several newly detected compounds linked to toxicity or the identification of as yet unidentified toxic effects of known compounds: the dinucleotide polyphosphates, structural variants of angiotensin II, interleukin-18, p-cresylsulfate and the guanidines. Toxic effects seem to be typically exerted by molecules which are “difficult to remove by dialysis”. Therefore, dialysis strategies have been adapted by applying membranes with larger pore size (high-flux membranes) and/or convection (on-line hemodiafiltration). The results of recent studies suggest that these strategies have better outcomes, thereby clinically corroborating the importance attributed in bench studies to these “difficult to remove” molecules.
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