Abstract
Because of its still rising incidence and high mortality rate in intensive care unit (ICU) patients, early recognition of acute kidney injury (AKI) remains a critical issue. Surprisingly, effective biomarkers for early detection and hence appropriate and timely therapy of AKI have not yet entered the clinical arena. We performed a systematic search of the literature published between 1999 and 2011 on potential early biomarkers for acute renal failure/kidney injury in an at-risk adult and pediatric population following the Quorum Guidelines. Based on this review, recommendations for the clinical use of these biomarkers were proposed. In general, kidney biomarkers may aid to direct early aggressive treatment strategies for AKI thereby decreasing the associated high mortality. To date, however, sensitivity and specificity of individual biomarker assays are low and do not sustain their routine clinical use. “Kits” containing a combination of established biomarkers, in conjunction with measured glomerular filtration rate, may enhance diagnostic and prognostic accuracy in the future.
Highlights
Accurate diagnosis of acute kidney injury (AKI) in an intensive care unit (ICU) setting is challenging
It has been evidenced that small or relative increases in serum creatinine are associated with a concomitant increase in patient mortality
Despite being aware of the AKI burden on outcome, ICU physicians remain deprived of effective biomarkers for early recognition of AKI
Summary
The characteristic swings in renal function over time in critically ill patients largely reduce the validity of a sole creatinine-based AKI assessment. This has stimulated researchers to establish multidimensional classification systems that use specific criteria to grade AKI severity. Plasma and urinary NGAL have shown promise as early biomarkers of clinical AKI in cardiopulmonary bypass surgery, kidney transplantation, following intravenous contrast administration, and in ICU patients [25,26,27,28,29]. NGAL and serum creatinine-derived GFR, measured at ICU admission, both predicted development of severe AKI. In the presence of normal serum creatinine values, NGAL alone remained predictive for AKI [45]
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