Advances in Acute Kidney Injury Associated with Cardiac Surgery: The Unfolding Revolution in Early Detection

作者：Wyckoff Tygh; Augoustides John G T^*

来源：Journal of Cardiothoracic and Vascular Anesthesia, 2012, 26(2): 340-345.

DOI：10.1053/j.jvca.2012.01.001

• serum creatinine
• glomerular filtration rate
• cardiac surgery
• acute kidney injury
• renal replacement therapy
• biomarkers
• clinical outcomes
• neutrophil gelatinase-associated lipocalin
• cystatin C
• kidney injury molecule 1
• interleukin-18
• research network
• clinical trial

Cardiac surgery-associated acute kidney injury (CSA-AKI) is important because it remains common and serious. A major limitation in the management of CSA-AKI has been ongoing delayed diagnosis by standard clinical approaches, including serum creatinine and calculated glomerular filtration rate. Recent advances in the understanding of CSA-AKI have highlighted the utility of novel biomarkers that diagnose CSA-AKI within the first 24 hours. The biomarkers that have been evaluated in clinical trials include neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule 1 and interleukin-18. The biomarker with the greatest clinical promise is NGAL. Although it has multiple advantages over serum creatinine, it is still not the ideal biomarker for CSA-AKI. It is likely that a panel of early biomarkers will be developed to facilitate rapid and reliable detection of CSA-AKI, combining their different characteristics to optimize patient management. Future clinical trials likely will focus on whether these biomarkers predict adverse outcomes independent of serum creatinine fluctuations and whether therapies guided by biomarker profiles improve renal salvage and overall clinical outcomes. Given their clinical utility, these novel biomarkers have been evaluated beyond cardiac surgery for AKI in multiple clinical environments, including the emergency department, the operating room, the cardiac catheterization laboratory, and the intensive care unit. Their integration into clinical practice seems likely in the near future.

• 出版日期2012-4