title: The ischemic/nephrotoxic acute kidney injury and the use of renal biomarkers in clinical practice.
abstract: The term Acute Renal Failure (ARF) has been replaced by the term Acute Kidney Injury (AKI). AKI indicates an abrupt (within 24-48h) decrease in Glomerular Filtraton Rate, due to renal damage, that causes fluid and metabolic waste retention and alteration of electrolyte and acid-base balance. The renal biomarkers of AKI are substances or processes that are indicators of normal or impaired function of the kidney. The most used renal biomarker is still serum creatinine that is inadequate for several reasons, one of which is its inability to differentiate between hemodynamic changes of renal function ("prerenal azotemia") from intrinsic renal failure or obstructive nephropathy. Cystatin C is no better in this respect. After the description of the pathophysiology of "prerenal azotemia" and of Acute Kidney Injury (AKI) due to ischemia or nephrotoxicity, the renal biomarkers are listed and described: urinary NAG, urinary and serum KIM-1, serum and urinary NGAL, urinary IL-18, urinary L-FABP, serum Midkine, urinary IGFBP7 and TIMP2, urinary α-GST and π-GST, urinary ɣGT and AP, urinary β2M, urinary RBP, serum and urinary miRNA. All have been shown to appear much earlier than the rise of serum Creatinine. Some of them have been demonstrated to predict the clinical outcomes of AKI, such as the need for initiation of dialysis and mortality.
authors.affiliation: Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy. Electronic address: andreucci@unicz.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Andreucci
authors.affiliation: Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Faga
authors.affiliation: Renal Unit, Department of Public Health, "Federico II" University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisani
authors.affiliation: Department of Experimental and Clinical Medicine, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Perticone
authors.affiliation: Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Ashour
authors.initials: A
authors.lastname: Michael
mesh_terms: D000136:Acid-Base Equilibrium; D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000503:physiopathology*; D015415:Biomarkers / Q000032:analysis*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: Acute renal failure; Biomarker; Creatinine; Ischemia reperfusion; Kidney disease; Renal disease