Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 68, Issue 1, Pages 19-28Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2015.12.033
Keywords
Acute kidney injury (AKI); biomarker; [TIMP-2] x [IGFBP7]; diagnosis; critically ill; tissue inhibitor of metalloproteinase 2; insulin-like growth factor binding protein 7; NephroCheck; early detection; risk assessment; renal dysfunction; decreased kidney function
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Funding
- Spectral Medical Inc and AM-Pharma
- Astute Medical Inc
- NIH [U01DK104308, U01DK085649]
- Abbott
- Achaogen Inc
- Chemocentryx Inc
- Durect Corporation
- Center for Sepsis and Critical Illness Award from the National Institute of General Medical Sciences [P50 GM-111152]
- Society of Critical Care Medicine
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Acute kidney injury (AKI) is a serious complication, commonly occurring in the critically ill population, with devastating short- and long-term consequences. Despite standardization of the definition and staging of AKI, early recognition remains challenging given that serum creatinine level is a marker, albeit imperfect, of kidney function and not kidney injury. Furthermore, the delay in increase in serum creatinine level after loss of glomerular filtration also prevents timely detection of decreased kidney function in patients with AKI. During the past decade, numerous clinical investigations have evaluated the utility of several biomarkers in the early diagnosis and risk stratification of AKI. In 2014, the US Food and Drug Administration approved the marketing of a test based on the combination of urine concentrations of tissue inhibitor of metalloproteinase 2 and insulinlike growth factor binding protein 7 ([TIMP-2] 3 [ IGFBP7]) to determine whether certain critically ill patients are at risk for developing moderate to severe AKI. The optimal role of this biomarker in the diagnosis, management, and prognosis of AKI in different clinical settings requires further clarification. In this perspective, we summarize the biological actions of these 2 cell-cycle arrest biomarkers and present important considerations regarding the clinical application, interpretation, and limitations of this novel test for the early detection of AKI. Am J Kidney Dis. 68(1): 19-28. (C) 2016 by the National Kidney Foundation, Inc.
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