Abstract：
Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect \"sub-clinical\" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.
摘要：
肾小球滤过率（GFR）的替代测量仍然是发病率的关键决定因素，严重程度,和急性肾损伤（AKI）的管理，以及支持其病理生理学知识的主要参考点。然而,除GFR下降外，AKI期间肾脏排泄功能方面的几个临床重要缺陷，包括酸碱调节，电解质和水平衡，和尿浓缩能力，当诊断标准是围绕纯粹基于GFR的评估建立时，可以逃避检测。已提出使用假定的肾小管损伤标志物来检测“亚临床”AKI，以扩展AKI的定义和诊断标准。但是它们的诊断性能因其生物学意义和背景特异性的模糊性而受到限制。在AKI中设计对整体肾功能损害的新的整体评估的努力将通过替代基于生物标志物阈值的诊断标准来促进更好地个性化患者护理的能力，并沿着病理生理连续体转变为对损害的评估。术语AKI是指突然肾脏恶化的综合征，其严重程度根据精确的诊断标准进行分类,这些诊断标准在患者管理中具有无可置疑的效用,同时也存在明显的局限性.特别是,缺乏明确的病理生理学定义的AKI限制了进一步的科学发展和临床处理，将该领域纳入其目前基于GFR的狭窄观点。一种基于对AKI中肾功能损害的更全面考虑的更新方法，作为新诊断概念的基础，该概念超出了当前基于GFR阈值的AKI分类所施加的界限。捕捉更广泛的发病机理，可以加强AKI的预防策略，改善AKI患者的预后和预后。
