Introduction
New biomarkers of AKI
Biomarker | Settings studied | Source | Measured from | Used for | Diagnostic accuracy (ROC) |
---|---|---|---|---|---|
NGAL | Cardiac surgery, ER, hospitalized patients, kidney Tx, sepsis, critically-ill patients | Leukocytes, loop of henle and collecting ducts | Serum plasma | Detection of established AKI, early diagnosis, prognosis | 0.53–0.96 |
Urine | |||||
Cystatin-C | Hospitalized patients, cardiac surgery | Nucleated cells | Serum plasma | Detection of established AKI, early diagnosis, prognosis | 0.79–0.89 |
Urine | |||||
KIM-1 | Hospitalized patients, cardiac surgery | Proximal tubular cells | Urine | Increased risk of AKI, established AKI, prognosis | 0.61–0.78 |
IL-18 | Cardiac surgery, ICU, hospitalized patients, Tx | Monocytes, dendritic cells, macrophages | Urine | Detection of established AKI, early diagnosis, prognosis | 0.70–0.95 |
FABPs | Contrast nephropathy, Sepsis, cardiac surgery, ischemic/reperfusion injury | Hepatocytes, proximal tubular cells | Urine | Detection of established AKI, progression to CKD | 0.84–0.96 |
TIMP-2 and IGFBP7 | Major surgery, sepsis, shock, trauma | Tubular epithelial cells | Urine | Detection of established AKI, prognosis | 0.76–0.85 |
EO | Cardiac surgery | Adrenal cells | Plasma | Identification of patients with increased risk of AKI | 0.73–0.80 |
Neutrophil gelatinase-associated lipocalin
Cystatin-C
Kidney injury molecule-1
Interleukin-18
Fatty acid–binding protein
TIMP-2 and IGFBP7
Endogenous ouabain
Other new potential biomarkers
Transition from AKI to CKD
NGAL
KIM-1
L-FABP
Ongoing problems with novel biomarkers
Sepsis-induced AKI
Tools for AKI predicion and severity diagnosis
Furosemide stress test
Renal functional reserve test
Models predicting AKI
Model name | CICSS | Cleveland clinic | STS | SRI | MCSPI | AKICS | NNECDSG | CLIN-RISK |
---|---|---|---|---|---|---|---|---|
First author | Chertow | Thakar | Mehta | Wijeysundera | Aronson | Palomba | Brown | Simonini |
Year of study | 1987–1994 | 1993–2002 | 2002–2004 | 1999–2004 | 1996–2000 | 2003–2005 | 2001–2005 | 2009–2012 |
Number of patients | 42,733 | 15,838 | 449,525 | 10,751 | 2381 | 603 | 8363 | 802 |
Outcome (%) | AKI-D (1.1) | AKI-D (1.7) | AKI-D (1.4) | AKI-D (1.3) | AKI-ND (4.8) | AKI-ND (11) | AKI-ND (3) | AKI-ND (9.9) |
ROC | 0.76 | 0.81 | 0.84 | 0.81 | 0.84 | 0.84 | 0.72 | 0.79 |
Validation (ROC) | Yes (0.71–0.78) | Yes (0.66–0.86) | Yes (0.75–0.81) | Yes (0.73–0.79) | Yes# (0.80) | Yes# (0.85) | Yes (0.76) | No |
Number of variables | 7 | 13 | 10 | 8 | 8 | 8 | 11 | 8 |
Demographics | X | X | X | X | X | X | ||
Clinical | X | X | X | X | X | X | X | X |
Operation type | X | X | X | X | X | X | ||
Intraoperative | X | X | ||||||
Postoperative | X |