Kidney damage in burn disease. Part 2. Biochemical markers (literature review)

PhD Yekhalov Vasyl Vitaliiovych, O. Kravets, V. Yekhalov, V. Gorbuntsov, D. Krishtafor
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Abstract

Recently discovered specific markers open up new possibilities for the diagnosis of acute kidney injury (AKI) in burn disease in order to optimize the treatment of such patients. Early diagnosis with the involvement of biomarkers prevents the sudden death of burn patients and allows predicting the course of the pathological condition. There are several characteristics that an “ideal” AKI biomarker should conform to: being non-invasive, locally specific, highly sensitive, being a stable molecule at different temperatures and pH values, having the ability to rapidly increase in response to kidney injury (quantify it), remaining at high levels during the episode and decreasing during the recovery period. There is a difference between the biomarkers that can be freely filtered in the glomerulus, so any increase in their plasma concentration (due to damage to other renal tissues) can lead to a high concentration of indicators in the urine (loss of specificity), and high-molecular-weight markers that are not freely filtered and therefore are more specific when measured in urine. Renal function in burn patients is usually determined by blood and urine tests, as biopsy can cause iatrogenic damage and is not commonly used in this cohort. After the onset of AKI, the level of biomarkers remains elevated for a certain period. None of the described indicators is monospecific for AKI; this makes estimating the time of AKI quite difficult. It has been proven that the combination of three biomarkers at two different time points in adults and the combination of two indicators at two time intervals in children allows to increase the reliability of determining AKI up to 0.78
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烧伤疾病的肾损伤。第 2 部分。生化指标(文献综述)
最近发现的特异性标志物为诊断烧伤疾病中的急性肾损伤(AKI)提供了新的可能性,以便优化对此类患者的治疗。利用生物标记物进行早期诊断可以防止烧伤病人猝死,并能预测病理过程。理想的 "AKI 生物标志物应符合以下几个特征:非侵入性、局部特异性、高灵敏度、在不同温度和 pH 值下是稳定的分子、能够迅速增加对肾损伤的反应(量化)、在发作期间保持高水平,并在恢复期间降低。在肾小球中可自由过滤的生物标志物与高分子量标志物之间存在差异,前者可自由过滤,因此其血浆浓度的任何增加(由于其他肾组织受损)都会导致尿液中指标的高浓度(失去特异性),而后者不能自由过滤,因此在尿液中测量时更具特异性。烧伤患者的肾功能通常通过血液和尿液检查来确定,因为活组织检查会造成先天性损伤,因此在这类患者中并不常用。发生 AKI 后,生物标志物的水平会在一段时间内持续升高。所描述的指标都不是针对 AKI 的单一特异性指标;这使得估计 AKI 的时间变得相当困难。事实证明,在成人中将三个生物标志物在两个不同的时间点结合起来,在儿童中将两个指标在两个时间间隔结合起来,可以将确定 AKI 的可靠性提高到 0.78。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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