Biologic markers for the early detection of acute kidney injury.
OBJECTIVE
This review discusses the current status of several biomarkers as potential diagnostic tools in patients with acute kidney disease.


RESULTS
Although the term "acute renal failure" has generally been used to describe acute kidney dysfunction that runs the spectrum from mild prerenal azotemia with no renal pathologic changes and no functional failure to severe oliguric renal dysfunction associated with tubular necrosis with failure of function, this spectrum is better described by the term "acute kidney injury." The mortality rate of hospitalized patients with severe acute kidney disease has not decreased significantly over the past 50 years despite advances in supportive care. The absence of sensitive and specific biomarkers for detecting injury early, grading the severity of the injury, and monitoring the response to therapy has impaired progress in the field and has had a very detrimental effect on the design and outcome of clinical trials in acute kidney disease. As a result of reliance on serum creatinine as a marker for injury and diagnosis, the institution of therapy is markedly delayed.


CONCLUSIONS
The search for new biomarkers for acute kidney injury is evolving rapidly with advancement in modern technologies. With better biomarkers we will have the ability to detect injury earlier, identify subclinical injury, provide prognostic information on the course of renal impairment, identify the nephron segments most affected, provide a rationale for segmentation of patients for clinical studies, guide timing of therapy, assess response to therapy, and screen patients at risk for renal injury.
Han
Won K
WK
Medical Services, Renal Division, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Bonventre
Joseph V
JV
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D015415:Biomarkers / Q000652:urine; D055515:Cysteine-Rich Protein 61; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D017874:Immediate-Early Proteins / Q000652:urine; D036341:Intercellular Signaling Peptides and Proteins / Q000652:urine; D020382:Interleukin-18 / Q000652:urine; D007683:Kidney Tubular Necrosis, Acute / Q000652:urine; D007687:Kidney Tubules, Proximal / Q000473:pathology*; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins / Q000652:urine; D011518:Proto-Oncogene Proteins / Q000652:urine; D011991:Receptors, Virus; D000074083:Sodium-Hydrogen Exchanger 3; D017923:Sodium-Hydrogen Exchangers / Q000652:urine
D000209:Acute-Phase Proteins; D015415:Biomarkers; C501848:CCN1 protein, human; D055515:Cysteine-Rich Protein 61; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D017874:Immediate-Early Proteins; D036341:Intercellular Signaling Peptides and Proteins; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; D000074083:Sodium-Hydrogen Exchanger 3; D017923:Sodium-Hydrogen Exchangers