Have biomarkers failed in acute kidney injury? No

Excerpt

Over the past decade, large prospective cohort studies have repeatedly shown that novel biomarkers are superior in performance to serum creatinine (SCr) in the early diagnosis and prognosis of acute kidney injury (AKI) with this data being summarized in recent reviews [1, 2]. Several investigations have linked these first-generation serum and urinary biomarkers of AKI [e.g., neutrophil gelatinase-associated lipocalin (NGAL) or tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein 7 (IGFBP7)] with adverse patient outcomes even in the absence of a change in SCr concentrations (biomarker-“positive”/creatinine-“negative” status) [3, 4]. We will delineate the barriers to biomarker development and validation in AKI while highlighting methods to overcome these barriers in an attempt to improve the management of patients with AKI. …