title: Renal angina: concept and development of pretest probability assessment in acute kidney injury.
abstract: The context of a diagnostic test is a critical component for the interpretation of its result. This context defines the pretest probability of the diagnosis and forms the basis for the interpretation and value of adding the diagnostic test. In the field of acute kidney injury, a multitude of early diagnostic biomarkers have been developed, but utilization in the appropriate context is less well understood and has not been codified until recently. In order to better operationalize the context and pretest probability assessment for acute kidney injury diagnosis, the renal angina concept was proposed in 2010 for use in both children and adults. Renal angina has been assessed in approximately 1,000 subjects. However, renal angina as a concept is still unfamiliar to most clinicians and the rationale for introducing the term is not obvious. We therefore review the concept and development of renal angina, and the currently available data validating it. We discuss the various arguments for and against this construct. Future research testing the performance of renal angina with acute kidney injury biomarkers is warranted.
authors.affiliation: Department of Medicine, Division of Intensive Care Medicine and Division of Nephrology, Veterans Affairs Medical Center, 50 Irving Street, Washington, DC, 20422, USA. minkchawla@gmail.com.|Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, 900 23rd Street, Washington, DC, 20037, USA. minkchawla@gmail.com.
authors.forename: Lakhmir S
authors.initials: LS
authors.lastname: Chawla
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, RILF2, Cininnati, OH, USA. stuart.goldstein@cchmc.org.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.affiliation: Department of Critical Care Medicine, Center for Critical Care Nephrology, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA. kellumja@ccm.upmc.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Department of Nephrology, Dialysis & Transplantation, International Renal Research Institute, San Bortolo Hospital, Via Bertesina, Vicenza, 36100, Italy. cronco@goldnet.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002648:Child; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D006801:Humans; D012307:Risk Factors
chemical_list: D015415:Biomarkers