Biomarker-Guided Risk Assessment for Acute Kidney Injury: Time for Clinical Implementation?

Acute kidney injury (AKI) is a common and serious complication in hospitalized patients, which continues to pose a clinical challenge for treating physicians. The most recent Kidney Disease Improving Global Outcomes practice guidelines for AKI have restated the importance of earliest possible detect...

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Bibliographic Details
Published in:Annals of laboratory medicine 2021, 41(1), , pp.1-15
Main Authors: Albert, Christian, Haase, Michael, Albert, Annemarie, Zapf, Antonia, Braun-Dullaeus, Rüdiger Christian, Haase-Fielitz, Anja
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - pathology
Biomarkers - blood
Biomarkers - urine
Cell Cycle Checkpoints
Creatinine - blood
Humans
Insulin-Like Growth Factor Binding Proteins - urine
Lipocalin-2 - blood
Lipocalin-2 - urine
Prognosis
Review
Risk Assessment
Tissue Inhibitor of Metalloproteinase-2 - urine
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Summary:Acute kidney injury (AKI) is a common and serious complication in hospitalized patients, which continues to pose a clinical challenge for treating physicians. The most recent Kidney Disease Improving Global Outcomes practice guidelines for AKI have restated the importance of earliest possible detection of AKI and adjusting treatment accordingly. Since the emergence of initial studies examining the use of neutrophil gelatinase-associated lipocalin (NGAL) and cycle arrest biomarkers, tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein (IGFBP7), for early diagnosis of AKI, a vast number of studies have investigated the accuracy and additional clinical benefits of these biomarkers. As proposed by the Acute Dialysis Quality Initiative, new AKI diagnostic criteria should equally utilize glomerular function and tubular injury markers for AKI diagnosis. In addition to refining our capabilities in kidney risk prediction with kidney injury biomarkers, structural disorder phenotypes referred to as "preclinical-" and "subclinical AKI" have been described and are increasingly recognized. Additionally, positive biomarker test findings were found to provide prognostic information regardless of an acute decline in renal function (positive serum creatinine criteria). We summarize and discuss the recent findings focusing on two of the most promising and clinically available kidney injury biomarkers, NGAL and cell cycle arrest markers, in the context of AKI phenotypes. Finally, we draw conclusions regarding the clinical implications for kidney risk prediction.
ISSN:2234-3806
2234-3814
DOI:10.3343/alm.2021.41.1.1