Urinary Biomarkers for Acute Kidney Injury in Critical Illness

描述（由申请人提供）：急性肾损伤（AKI）常见于危重患者。血清肌酐是肾功能较差的指标。在AKI的预防和治疗方面缺乏进展可能是由于研究中缺乏早期可靠诊断AKI的生理指标。尿IL-18、中性粒细胞明胶酶相关脂钙蛋白（NGAL）和胱抑素C是AKI早期检测和潜在风险分层的三个有前景的生物标志物。本初步研究的第一个目的是评估尿IL-18、NGAL和胱抑素C作为脓毒症和/或急性肺损伤患者AKI早期检测的生物标志物。第二个目的是确定尿IL-18、NGAL和胱抑素C浓度是否可以在肾替代治疗的需要和住院死亡率方面对AKI患者进行风险抑制。本研究的结果将通过开发研究过程和数据收集，帮助以后指导确定的大型多中心研究；指导样本采集时间和事件率总体样本量；确定适合生物标志物研究的AKI重要亚组，最后通过建立一个生物标志物小组，在ICU环境中早期可靠地诊断AKI，具有增加的预后价值。与公共卫生相关：2006年，我们诊断突发性肾衰竭的能力是不准确和低效的。通过尿液中新发现的蛋白质来早期识别突发性肾衰竭将有助于医疗保健提供者做出及时诊断，并可能预测肾衰竭的严重程度。此外，它将帮助研究人员进行有效的药物开发研究，通过使他们能够更快地识别和招募肾功能衰竭患者来改善肾功能衰竭。

DESCRIPTION (provided by applicant): Acute kidney injury (AKI) is common in critically ill patients. Serum creatinine is a poor marker of renal function. The lack of progress in the prevention and treatment of AKI may be attributable to poor physiologic markers for early and reliable diagnosis of AKI in reseach studies. Urinary IL-18, neutrophil gelatinase- associated lipocalin (NGAL), and cystatin C are three promising biomarkers for the early detection and potential risk-stratification of AKI. The first aim of this pilot study is to evaluate urine IL-18, NGAL, and cystatin C as biomarkers for the the early detection of AKI in patients with sepsis and/or acute lung injury. The second aim is to determine if urinary IL-18, NGAL, and cystatin C concentrations can risk-statify patients with AKI in terms of the need for renal replacement therapy and in-hospital mortality. The results from this study will help later guide a definitive large multicenter study by developing the study processes and data collection; guiding duration of sample collection and overall sample size for event rates; identifying important subgroups of AKI amenable to study with biomarkers, and finally by developing a biomarker panel for the early and reliable diagnosis of AKI in the ICU setting that has incremental prognostic value. Relevance to public health: In 2006, our ability to diagnose abupt kidney failure is inaccurate and inefficient. Earlier recognition of abrupt kidney failure via newly discovered proteins in the urine will aid health care providers in making a prompt diagnosis, and may predict how severe the kidney failure will be. Furthermore, it will help researchers to perform efficient studies of drug development studies to improve kidney failure by enabling them to identify and enroll patients will kidney failure more rapidily.