Podometrics as a Potential Clinical Tool for Glomerular Disease Management.
Podometrics as a Potential Clinical Tool for Glomerular Disease Management.
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阶数字法作为肾小球疾病管理的潜在临床工具。
DOI：
10.1016/j.semnephrol.2015.04.004
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发表时间：
2015-05
影响因子：
3.3
通讯作者：
Wiggins RC
中科院分区：
文献类型：
--
作者：
Kikuchi M;Wickman L;Hodgin JB;Wiggins RC
慢性肾病最终发展为终末期肾病，是一个主要的公共卫生问题，每年花费超过400亿美元，发病率和死亡率高。目前用于肾小球疾病监测的工具缺乏精确性，导致不良结局。足细胞耗竭假说描述了导致>80% ESKD的肾小球疾病进展的主要机制。问题是，这些新知识是否可以用来改善结果和降低成本。足细胞具有独特的特性，使其成为一种有吸引力的监测工具。用于在常规肾活检中估计足细胞数量、大小、密度、肾小球体积和其他参数以及足细胞从肾小球脱离到尿液中的速率（“足细胞测定法”）的方法现在已经被开发和验证。它们可能填补肾小球疾病监测工具箱中的重要空白。这些工具在肾小球疾病组中的应用表明与结果具有良好的相关性，尽管尚未获得验证其用于个体决策的数据。鉴于临床问题的紧迫性，我们认为，现在是时候把重点放在测试这些工具的应用到个性化的临床决策，以更有效地预防疾病进展。
Chronic Kidney Disease culminating in End Stage Kidney Disease is a major public health problem costing in excess of $40 billion per year with high morbidity and mortality. Current tools for glomerular disease monitoring lack precision and contribute to poor outcome. The podocyte depletion hypothesis describes the major mechanisms underlying progression of glomerular diseases responsible for >80% of ESKD. The question arises whether this new knowledge can be used to improve outcomes and reduce costs. Podocytes have unique characteristics that make them an attractive monitoring tool. Methodologies for estimating podocyte number, size, density, glomerular volume and other parameters in routine kidney biopsies, and the rate of podocyte detachment from glomeruli into urine (“podometrics”), have now been developed and validated. They potentially fill important gaps in the glomerular disease monitoring toolbox. Application of these tools to glomerular disease groups demonstrates good correlation with outcome, although data validating their use for individual decision-making is not yet available. Given the urgency of the clinical problem we argue that the time has come to focus on testing these tools for application to individualized clinical decision-making towards more effective progression prevention.