title: Clinical use of biomarkers for toxicant-induced acute kidney injury.
abstract: Toxicant-induced acute kidney injury (ToxAKI) causes substantial morbidity and retards drug development. ToxAKI is relatively underexplored compared with ischemia-reperfusion injury in clinical biomarker studies. We highlight the rationale for novel AKI biomarkers in management of ToxAKI, and review the contemporary evidence supporting their clinical use. Directly-acting nephrotoxins, such as cisplatin, aminoglycosides, vancomycin and radiocontrast, remain widely used and highlight how novel biomarkers can either improve the detection of changes in glomerular filtration rate or directly signal cellular injury and structural damage. Serum cystatin C has already improved clinical risk prediction and drug dosing although its clinical use for early diagnosis awaits validation. The use of novel functional and structural biomarkers to stage ToxAKI and aid prognosis requires robust validation and better understanding of the relationship between biomarkers, morbidity and mortality. Biomarkers that illustrate the probable mechanisms and phase of ToxAKI may guide mechanism-specific diagnosis and therapy.
authors.affiliation: Department of Nephrology, Prince of Wales Hospital High Street, Randwick, Sydney, NSW 2031, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Pianta
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Buckley
authors.forename: Philip W
authors.initials: PW
authors.lastname: Peake
authors.forename: Zoltan H
authors.initials: ZH
authors.lastname: Endre
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000139:chemically induced / Q000175:diagnosis*; D000818:Animals; D015415:Biomarkers / Q000097:blood*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D011379:Prognosis
chemical_list: D015415:Biomarkers