title: Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury.
abstract: OBJECTIVE
  Several novel urinary biomarkers have shown promise in the early detection and diagnostic evaluation of acute kidney injury (AKI). Clinicians have limited tools to determine which patients will progress to more severe forms of AKI at the time of serum creatinine increase. The diagnostic and prognostic utility of novel and traditional AKI biomarkers was evaluated during a prospective study of 123 adults undergoing cardiac surgery.
  
  
  METHODS
  Urinary neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CyC), kidney injury molecule-1 (KIM-1), hepatocyte growth factor (HGF), π-glutathione-S-transferase (π-GST), α-GST, and fractional excretions of sodium and urea were all measured at preoperative baseline, postoperatively, and at the time of the initial clinical diagnosis of AKI. Receiver operator characteristic curves were generated and the areas under the curve (AUCs) were compared.
  
  
  RESULTS
  Forty-six (37.4%) subjects developed AKI Network stage 1 AKI; 9 (7.3%) of whom progressed to stage 3. Preoperative KIM-1 and α-GST were able to predict the future development of stage 1 and stage 3 AKI. Urine CyC at intensive care unit (ICU) arrival best detected early stage 1 AKI (AUC = 0.70, P < 0.001); the 6-hour ICU NGAL (AUC = 0.88; P < 0.001) best detected early stage 3 AKI. π-GST best predicted the progression to stage 3 AKI at the time of creatinine increase (AUC = 0.86; P = 0.002).
  
  
  CONCLUSIONS
  Urinary biomarkers may improve the ability to detect early AKI and determine the clinical prognosis of AKI at the time of diagnosis.
authors.affiliation: Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: Jay L
authors.initials: JL
authors.lastname: Koyner
authors.forename: Vishal S
authors.initials: VS
authors.lastname: Vaidya
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bennett
authors.forename: Qing
authors.initials: Q
authors.lastname: Ma
authors.forename: Elaine
authors.initials: E
authors.lastname: Worcester
authors.forename: Shahab A
authors.initials: SA
authors.lastname: Akhter
authors.forename: Jai
authors.initials: J
authors.lastname: Raman
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Micheal F
authors.initials: MF
authors.lastname: O'Connor
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Bonventre
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Murray
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine*; D055316:Cystatin C / Q000652:urine; D042241:Early Diagnosis; D005260:Female; D005982:Glutathione Transferase / Q000652:urine; D000072596:Hepatitis A Virus Cellular Receptor 1; D017228:Hepatocyte Growth Factor / Q000652:urine; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve; D011991:Receptors, Virus
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; D017228:Hepatocyte Growth Factor; D005982:Glutathione Transferase
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