Lub raum: Muaj nuj nqi, Cells thiab Biomarkers

Lub raum ua lub luag haujlwm tseem ceeb hauv homeostasis, tswj qhov chaw sab hauv, thiab ua kom lub cev muaj zog rau kwv yees li 100 trillion hlwb hauv tib neeg lub cev. Lub nephron's anatomic histological qauv, nrog ntau tshaj 20 hom ntawm cov hlwb tshwj xeeb qhia tau hais tias ib qho kev sib koom ua ke tsom mus rau qhov tsis zoo ntawm endothelium / epithelium ua haujlwm sib cuam tshuam. Cov kab mob pathophysiological tuaj yeem ua rau muaj kev hloov pauv rau qhov chaw sab hauv thiab cov zis, ua pov thawj los ntawm cov cim ntawm kev ua haujlwm tsis zoo thiab cov molecules cuam tshuam nrog kev raug mob ntawm tes.Uremiayog thawj biomarker ntawmLub raumkev ua haujlwm tsis zoo(18th caug xyoo) thiab tau los ua ib lub ntsiab lus rauraumua tsis tiav(KF). Creatinine (19th caug xyoo) coj kev nkag siab zoo dua ntawmglomerularlimthiab, txij thaum ntawd los, nws yog tus siv biomarker tshaj plaws hauvnephrology. Cystatin C (20th caug xyoo) yog biomarker tsis ntev los no tau tsim los txhawm rau txheeb xyuas thiab faib cov theem ntawmraummuaj nuj nqi. Cov molecules no, nyob rau hauv siab concentrations, integrate classical KF metabolome thiab sawv cev rau lub metabolic kos npe ntawm txawv yav dhau los biological phenomena uas, nyob rau hauv ib tug mob los yog mob ntev, ua rau lub raum tsis ua hauj lwm.

Nyem rau cistanche deserticola extract rau mob raum kab mob

Nrog rau ntau yam ntawm cov ntsiab lus, urinalysis tam sim no muaj ib txheej ntawm physiological thiab pathophysiological biomarkers, muaj peev xwm nthuav tawm cov ntaub ntawv teev nyob rau hauv peb lub sij hawm nyob rau hauv lub sij hawm: biological phenomena uas twb tshwm sim, phenomena nrog tshwm sim nyob rau hauv tam sim no, los yog txawm kwv yees ntawm yav tom ntej cov xwm txheej, nyob. los yog tsis nyob rau hauv txoj kev tso zis. Kev noj cov zis tso zis, piv txwv li, peb tuaj yeem pom lawv hauv txhua lub sijhawm no nrog, feem, myoglobinuria, Bence Jones protein, thiab microalbuminuria.

Txawm hais tias nws yog tus nqi qis thiab yooj yim rau kev txhaj tshuaj, creatinine muaj cov ntshav ib nrab-lub neej ntawm 4 teev thiab siv sijhawm txog 40 teev rau nws cov concentration qhia.Mob hnyavLub raumKev raug mob(AKI), lub sijhawm ntev thaum nws los txog rau cov neeg mob hnyav. AKI qhov kev loj hlob ntawm cov neeg tuag coob nyob rau hauv lub xyoo pua XXI tau ua rau kev tshawb nrhiav ntxov ntawm cov kab mob ntawm cov kab mob hauv lub cev, 1 tshwj xeeb tshaj yog mob tubular necrosis (ATN), tsom rau kev cia siab txog cov kev ntsuas tsim nyog thiab kev cuam tshuam zoo hauv keeb kwm ntawm AKI. Yog li, ob peb lub cim tshiab tau raug npaj: 2 NGAL (neutrophil gelatinase-associated lipocalin); KIM-1 (Acute Kidney Injury molecule-1); L-FABP (lub siab fatty acid-binding protein); IGFBP7 (insulin-zoo li kev loj hlob zoo-binding protein 7); IL-18 (interleukin-18); TIMP-2 (metallopeptidase-2 inhibitor); MCP- 1 (monocyte chemotactic peptide-1); CCL{17}} (chemokine CCL-14); CHI3L1 (chitinase-3-zoo li protein 1).

Raws li Claude Bernard indoctrinated nyob rau hauv Cov Ntsiab Cai ntawm Kev sim tshuaj (1865), 3 "Kev Qhia Txuj Ci": thaum muaj qhov tshwm sim tas li raug sim, lawv lees paub lawv qhov kev xav lossis tsis yog. Hauv qhov kev nkag siab no, txij li lawv qhov kev tshawb pom, ntau qhov kev tshawb fawb tau sim sib txawv ATN biomarkers, txhawm rau txheeb xyuas lawv hauv ntau hom kev kho mob. Raws li lawv nthuav tawm kev puas tsuaj rau tubular epithelium, qee qhov ntawm cov kev txwv no raug cuam tshuam los ntawm hnub nyoog, poj niam txiv neej, kis kab mob, thiabmob ntevraumkab mob, tshwj xeeb tshaj yog nyob rau hauv tubule-interstitial kev koom tes, uas cuam tshuam rau lub epithelial hlwb.4

Hauv tsab ntawv no, qhov kev tshawb fawb cuam tshuam los ntawm Tavares et al5 qhia txog kev soj ntsuam kev soj ntsuam zoo uas siv ob lub cim kab mob qog nqaij hlav, NGAL thiab KIM-1, ua rau cov neeg mob uas muaj lub raum tsis ua haujlwm tam sim ntawd, tab sis leej twg paub txog. muaj nephrotic syndrome kab mob ntawm ntau yam ua rau. Kev txhim kho tsis ntev los no ntawm cov kab mob tshwj xeeb rau kev ua tus yam ntxwv ntawm cov kab mob glomerular tau maj mam ua qhov khoob hauv kev paub txog glomerulopathies.6 Txawm li cas los xij, nyob rau hauv chav kho mob ntawm nephrotic syndrome, nws tsis yog qhov tsis yooj yim rau cov neeg mob los nthuav qhia qhov nce siab ntawm cov ntshav creatinine vim muaj tshuaj lom. , ischemic, lossis NTA-origin sepsis. Qhov kev kuaj mob xav tau yog vim qhov tseeb tias qhov mob hnyav kuj tuaj yeem tshwm sim los ntawm qhov ua rau muaj tus kab mob glomerular zuj zus, qee zaum yuav tsum tau kuaj lub raum kom paub meej. Qhov tseem ceeb ntawm qhov kev txhais no yog qhov ncaj ncees, vim tias cov kev kho mob tsim nyog muaj ntau yam, raws li qhov xwm txheej tau kuaj pom. Hauv cov ntawv no, cov kws sau ntawv piav qhia tias kev siv tib lub sijhawm ntawm ob lub urinary biomarkers tau txheeb xyuas qhov zoo thiab muaj txiaj ntsig histopathological koom haum kom sib txawv seb qhov tsos mob ntawm lub raum tsis ua haujlwm tau tshwm sim los ntawm kev sib tshooj ntawm kev thuam ntawm epithelial los yog los ntawm kev siv zog ntawm glomerular insult. Qhov kev pab no qhia tau hais tias muaj peev xwm siv tau ntawm txoj kev no los saib xyuas cov neeg mob uas muaj ntau hom kab mob glomerular.

Nrog rau qhov kev tshaj tawm no, Tavares et al. txhawb kev tshawb nrhiav tshiab ntawm cov ntsiab lus uas yuav tsum tau ua nrog NGAL, KIM-1, thiab lwm yam molecules. Thib ob-tiam biomarkers, TIMP-2 thiab IGFBP-7,7 uas cuam tshuam txog kev cuam tshuam ntawm cell-cycle interruption ntawm cov hlwb nyob rau hauv lub proximal thiab distal tubular epithelium tej zaum yuav raug kuaj. Qee tus ntawm lawv kuaj xyuas cov cell insults, 7,8 suav nrog cov sublethal, los ntawm kev kho mob lossis phais kev nyuaj siab, txawm tias thawj 12 teev, raws li lawv kuj tau siv los txheeb xyuas qhov mob ntawm AKI epithelial lesions nyob rau hauv AKIN 2 thiab 3 theem.9 Cov lus cog tseg. Kev cia siab yog tias, nyob rau yav tom ntej, cov biomarkers yuav sib sau ua cov cuab yeej rau kev pheej hmoo stratification thiab hnyav hauv AKI, nrog rau cov ntsiab lus ntawm tus kheej cov txheej txheem kho mob, suav nrog hauv glomerulopathies.

Yog li ntawd, nephrology kuj qhia peb tias qhov sib txuas tsis tau ntawm endothelium-epithelium interconnection, yog li tsim nyog rau physiology, tsis yog ua tiav los ntawm cov xwm txheej pathophysiological, uas, zoo, glomerulopathies tsis cuam tshuam los ntawm tauopathies.

Cov ntaub ntawv

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2. Srisawat N, Kellum JA. Lub luag haujlwm ntawm biomarkers hauv mob raum raug mob. Crit Care Clin. 2020 Jan;36(1):125-40.

3. Bernard C. Introduction à l'etude de la médecine expérimentale. Paris: JB Baillière thiab fils; Xyoo 1865.

4. Malhotra R, Katz R, Jotwani V, Ambrosius WT, Raphael KL, Haley W, et al. Cov cim tso zis ntawm lub raum tubule cell raug mob thiab lub raum ua haujlwm poob qis hauv SPRINT cov neeg koom nrog CKD. Clin J Am Soc Nephrol. Peb Hlis 2020; 15(3):349-58.

5. Tavares MB, Melo CVB, Fernandes PN, Almeida MCC, Carneiro MFSM, Santos RFS, et al. Biomarkers ntawm mob raum raug mob rau cov neeg mob uas muaj nephrotic syndrome. Braz J Nephrol. 2020 Sep 11; [Epub ua ntej luam tawm].

6. Caliskan Y, Kiryluk K. Novel biomarkers nyob rau hauv kab mob glomerular. Adv Chronic Kidney Dis. 2014 Mar; 21(2):205-16.

7. Nalesso F, Cattarin L, Gobbi L, Fragasso A, Garzotto F, Calò LA. Ntsuas Nephrocheck® ua ib qho cuab yeej twv ua ntej rau mob raum raug mob. Int J Nephrol Renovasc Dis. Lub Plaub Hlis 2020; 2020:85-96.

8. De Loor J, Decruyenaere J, Demeyere K, Nuytinck L, Hoste EAJ, Meyer E. Urinary chitinase 3-zoo li protein 1 rau kev kuaj mob ntxov ntawm lub raum raug mob: kev kawm yav tom ntej hauv cov neeg laus mob hnyav. Crit Care. Peb 20, 2016; 20:38 PM

9. Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kab mob raum: Txhim kho Ntiaj Teb Cov Txheej Txheem (KDIGO) mob raum raug mob workgroup. KDIGO Clinical practice guideline for mob raum raug mob. Raum Int Suppl. 2012 Mar; 2(1): 19-36.

1 Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

2 Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

Sau: Mauricio Younes-Ibrahim1,2

Yog xav paub ntxiv:Ali.ma@wecistanche.com