title: Repair or progression after AKI: a role for biomarkers?
abstract: Recent progress in biomarkers represents a paradigm shift in acute kidney injury (AKI) research. Most studies have evaluated the use of these biomarkers for early diagnosis of AKI. However, the role of novel biomarkers in predicting renal recovery, though less understood, holds great clinical promise. Accurate prediction would help physicians distinguish patients with poor renal prognosis in whom further therapy is unlikely to be useful from those who are likely to have good renal prognosis. Unfortunately, current general clinical severity scores (APACHE, SOFA, etc.) and AKI-specific severity scores are not good predictors of renal recovery. The biology of renal recovery requires the repopulation by surviving renal tubular epithelial cells with the assistance of certain renal epithelial cell and specific growth factors such as neutrophil gelatinase-associated lipocalin (NGAL), hepatocyte growth factor (HGF), epidermal growth factor, and insulin-like growth factor-1 (IGF-1), etc. These markers play a major role in the recovery process. This review will describe the mechanisms of the renal recovery, epidemiology, the role of conventional clinical predictors and finally the role of novel biomarkers (NGAL, HGF, IL-8, IL-18, TNFR-1, IGF-binding protein-7 and tissue inhibitor of metalloproteinase-2) in predicting renal recovery.
authors.affiliation: Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross, and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Nattachai
authors.initials: N
authors.lastname: Srisawat
authors.forename: Raghavan
authors.initials: R
authors.lastname: Murugan
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D015415:Biomarkers / Q000032:analysis* / Q000097:blood / Q000652:urine; D002454:Cell Differentiation; D015331:Cohort Studies; D018450:Disease Progression; D004231:Diuresis; D004847:Epithelial Cells / Q000473:pathology; D006801:Humans; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D007378:Interleukins / Q000097:blood; D007668:Kidney / Q000502:physiology; D007687:Kidney Tubules, Proximal / Q000473:pathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D015337:Multicenter Studies as Topic; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood; D020127:Recovery of Function; D012038:Regeneration; D018570:Risk Assessment; D012720:Severity of Illness Index; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000097:blood / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D018969:Insulin-Like Growth Factor Binding Proteins; D007378:Interleukins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D047888:Receptors, Tumor Necrosis Factor, Type I; C102529:insulin-like growth factor binding protein-related protein 1; D019716:Tissue Inhibitor of Metalloproteinase-2