Биомаркеры нефротоксичности: роль и значимость в диагностике лекарственного повреждения почек

Лекарственное поражение почек составляет от 8 до 60% эпизодов острого повреждения почек (ОПП) среди госпитализированных пациентов. Как можно более раннее распознавание этого состояния и своевременное принятие мер по коррекции лечения могут уменьшить количество выявленных случаев почечного повреждения и летальных исходов. Цель работы: анализ данных научной литературы о биомаркерах, используемых при проведении диагностики лекарственного поражения почек. Выявлено, что такие маркеры повреждения почек, как уровень сывороточного креатинина, объем выделяемой мочи, концентрация азота мочевины, экскреция натрия, микроскопия мочевого осадка, ограничены в применении в связи с тем, что они не отражают в полном объеме динамику и степень повреждения почек и не позволяют диагностировать развитие ОПП на ранних этапах. Установлено, что наи более перспективными биомаркерами являются в первую очередь KIM-1, L-FABP, NAG, NGAL, цистатин С, кластерин, β2-микроглобулин, МСР-1, IGFBP7 и TIMP-2. Однако определение концентрации новых биомаркеров в моче или в крови для диагностики ОПП может носить лишь рекомендательный характер, так как клинических и доклинических исследований по установлению валидности такого рода тестов проведено недостаточно. До настоящего времени не разработаны точные алгоритмы оценки рисков развития, диагностики, мониторинга течения и терапии ОПП, основанные на определении наличия и уровней данных маркеров в моче и/или в сыворотке крови. Таким образом, необходимо продолжать исследования различных биомаркеров ОПП и совершенствовать экспериментальные модели (как in vivo, так и in vitro), в том числе для изучения потенциальных нефротоксических свойств уже известных и разрабатываемых лекарственных средств.

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