Physiological biomarkers of acute kidney injury: a conceptual approach to improving outcomes.

The past 5–10 years have brought significant advances in the identification and validation of novel biochemical biomarkers in the prevention and treatment of acute kidney injury (AKI). These biochemical biomarkers remain research tools but we anticipate that soon they will be employed in clinical practice. A Consensus Conference held by the Acute Dialysis Quality Initiative (ADQI) recently reviewed the evidence, and identified gaps and a research agenda. Furthermore, at this meeting was the birth of an initiative to comprehensively identify new opportunities to characterize the physiological changes during the course of AKI based upon a conceptual framework for the detection and monitoring of renal ischemia-reperfusion injury. This framework includes a transition from monitoring physiological biomarkers of adequate renal perfusion, to pathophysiologic biomarkers of renal hypoperfusion, and finally biomarkers of kidney cell structural injury/damage. Techniques to measure physiological changes in AKI include several physiological variables that might be used in an interactive way to supplement clinical information and biochemical damage biomarkers in the diagnosis and management of AKI. This review summarizes the spectrum of physiological parameters and potential new physiological methods that enable identification of high-risk patients for AKI, facilitate early diagnosis, and differential diagnosis to guide therapeutic management and prognostication. Finally, we propose a research agenda for the next 5 years to facilitate the development and validation of physiological biomarkers in AKI.

在急性肾损伤（AKI）的预防和治疗中，过去5 - 10年在新型生物化学标志物的识别和验证方面取得了重大进展。这些生物化学标志物仍然是研究工具，但我们预计不久它们将应用于临床实践。急性透析质量倡议（ADQI）最近召开的一次共识会议回顾了相关证据，确定了差距并制定了研究议程。此外，在这次会议上诞生了一项倡议，即基于一个用于检测和监测肾缺血 - 再灌注损伤的概念框架，全面寻找新的机会来描述AKI过程中的生理变化。这个框架包括从监测肾灌注充足的生理标志物，到肾灌注不足的病理生理标志物，最后到肾细胞结构损伤的标志物的转变。测量AKI生理变化的技术包括几个生理变量，这些变量可能以交互方式使用，以补充AKI诊断和管理中的临床信息和生物化学损伤标志物。这篇综述总结了生理参数的范围以及潜在的新的生理方法，这些方法能够识别AKI高危患者，促进早期诊断和鉴别诊断，以指导治疗管理和预后判断。最后，我们提出了未来5年的研究议程，以促进AKI生理标志物的开发和验证。