Improving acute kidney injury diagnostic precision using biomarkers

Acute kidney injury (AKI) is common in hospitalized patients of all ages and is associated with significant morbidity and mortality. Accurate prediction and early identification of AKI is of utmost importance because no therapy exists to mitigate AKI once it has occurred. Yet, serum creatinine lacks adequate sensitivity and specificity, and quantification of urine output is challenging in incontinent children without indwelling bladder catheters. Integration of clinically available biomarkers have the potential to delineate unique AKI phenotypes that could have important prognostic and therapeutic implications. Plasma Cystatin C, urine neutrophil gelatinase associated lipocalin (NGAL) and the urinary product of tissue inhibitor metalloproteinase (TIMP2) and insulin growth factor binding protein-7 (IGFBP7) are clinically available. These biomarkers have been studied in heterogenous populations across the age spectrum and in a variety of clinical settings for prediction of AKI. The purpose of this review is to describe and discuss the clinically available AKI biomarkers including how they have been used to delineate AKI phenotypes.

Automated summary

Acute kidney injury (AKI) is common in hospitalized patients and has significant morbidity and mortality. Accurate prediction and early identification of AKI is crucial, although current therapies are limited. Clinical biomarkers, such as plasma Cystatin C, urine NGAL, TIMP2, and IGFBP7, have been studied for their potential in predicting AKI. This review focuses on the description and discussion of these clinically available AKI biomarkers and their use in delineating AKI phenotypes.