运动性急性肾损伤与新型肾功能生物标志物

Exercise-induced Acute Kidney Injury and Novel Renal Function Biomarkers

大强度运动中,非创伤性急性肾损伤(acute kindey injury,AKI)经常发生,表现为血尿、蛋白尿、血红蛋白尿等。一般认为,中低程度的运动性急性肾损伤是可逆的,可完全恢复。但动物实验与人类研究均发现,严重的运动性肾损伤会导致“功能性”急性肾损伤发展为“结构性”急性肾损伤,并增加慢性肾病的风险。运动性急性肾损伤对机体的潜在健康威胁已引起国内外相关领域学者的广泛关注。血清肌酐(serum creatinine,Scr)和尿量作为肾功能的传统经典标志物,不能特异性反映早期肾损伤,而新型肾损伤标志物可进一步明确损伤的位置及严重程度。在运动领域,利用新型生物标志物进行无创性检查,识别早期运动性急性肾损伤非常必要。本文综述了反映肾小球或肾小管损伤、细胞周期停滞和肾损伤修复的新型生物标志物,着重论述了尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和肾损伤分子-1(KIM-1)与肾功能的关系,以及长时间耐力运动、急性运动和高强度间歇阻力运动3种运动形式对肾功能的影响,旨在引起重视,精准识别风险,及时进行早干预。

Non-traumatic acute kidney injury(AKI)occurs frequently in high-intensity exercises,manifesting as hematuria,albuminuria,hemoglobin urine and so on.It is generally believed that the medium and low degree of exercise AKI is reversible and can be completely recovered.However,both animal experiments and human studies have found that severe exercise-induced kidney injury can lead to the development of“functional“AKI to“structural”AKI,and increase the risk of chronic kidney diseases.The potential health threat of exercise-induced AKI to the individual has attracted extensive attention of scholars in related fields.The classical biomarkers for kidney function,such as serum creatinine and urinary outputs,lack specificity for damage to kidneys,while novel urinary kidney injury markers may provide insight into the location and severity of injury.Timely and non-invasive diagnosis of kidney injuries are necessary in sports.In this article,we review novel biomarkers reflecting glomerular or tubular damages,cell cycle arrest and renal injury repair,focusing on the relationship between urinary NGAL/KIM-1 and renal function,as well as the risk of long-term endurance exercises,acute exercise and high intensity intermittent resistance exercise on renal functions,aiming at evoking a universal attention to early and precision intervention of exercise-induced AKI.