Risk Stratification for Acute Kidney Injury: Are Biomarkers Enough?
Acute kidney injury (AKI) is a common and serious complication that is associated with several adverse outcomes in hospitalized patients. AKI significantly increases the risk of mortality, need for renal replacement therapy, and intensive care admission, and it also has serious economic ramifications. Effective risk stratification to identify patients at risk for severe AKI is essential for targeting our health care and research resources to tackle this important public health issue. The overwhelming majority of research in earlier diagnosis and risk stratification of AKI over the past 10 years has focused on novel biomarker development. The purpose of this review is to provide an update on other novel risk stratification tools than can be used in the prognostication of AKI. We discuss the utility of the furosemide stress test in predicting the severity of AKI and the renal angina index in predicting the occurrence of AKI. We also discuss NephroCheck, a prognostic test that measures tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 for the early detection of severe AKI.
Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD; and Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL.
Blaithin A
BA
McMahon
Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD; and Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL. Electronic address: jkoyner@medicine.bsd.uchicago.edu.
Jay L
JL
Koyner
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015415:Biomarkers; D003422:Critical Care; D004232:Diuretics; D042241:Early Diagnosis; D005665:Furosemide; D006801:Humans; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000097:blood
D015415:Biomarkers; D004232:Diuretics; D018969:Insulin-Like Growth Factor Binding Proteins; C560823:TIMP2 protein, human; C102529:insulin-like growth factor binding protein-related protein 1; D019716:Tissue Inhibitor of Metalloproteinase-2; D005665:Furosemide
Acute kidney injury; Biomarkers; Renal replacement therapy; Risk assessment