Early detection of acute kidney injury: emerging new biomarkers.
Acute kidney injury (AKI) has recently become the preferred term to describe the syndrome of acute renal failure (ARF) with 'failure' or 'ARF' restricted to patients who have AKI and need renal replacement therapy.(1) This allows capture of the broader clinical spectrum of modest reductions in creatinine, which are themselves known to be associated with major increases in both short- and long-term mortality risk.(2-5) It is hoped that this change in nomenclature will facilitate an expansion of our understanding of the underlying pathophysiology and also facilitate definitions of AKI, which allow comparisons among clinical trials of patients with similar duration and severity of illness. This review will cover the need for early detection of AKI and the role of urinary and plasma biomarkers, including enzymuria. The primary message is that use of existing criteria to diagnose AKI, namely elevation of the serum creatinine with or without oliguria, results in identification that is too late to allow successful intervention. New biomarkers are essential to change the dire prognosis of this common condition.
Endre
Zoltan H
ZH
Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand. zoltan.endre@chmeds.ac.nz
Westhuyzen
Justin
J
D058186:Acute Kidney Injury / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000401:mortality / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000652:urine; D042241:Early Diagnosis; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D020382:Interleukin-18 / Q000652:urine; D007684:Kidney Tubules / Q000201:enzymology / Q000378:metabolism; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008562:Membrane Glycoproteins / Q000652:urine; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000652:urine; D011991:Receptors, Virus; D013577:Syndrome; D009626:Terminology as Topic
D000209:Acute-Phase Proteins; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; D003404:Creatinine