Biomarkers for early detection of acute kidney injury

Won K Han

Department of Medicine, Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

Abstract: It is very difficult to make an early diagnosis of acute kidney injury (AKI) using serum creatinine, which is the standard metric tool for the detection of renal injury. The absence of sensitive AKI biomarkers has impaired progress in the nephrology field and had a detrimental effect on the design and outcome of AKI clinical trials. Recently, several proteins have shown potential in the early detection of AKI, including neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18. This review discusses the current status of three AKI biomarkers as a potential diagnostic tool for the early detection of AKI. The focus is limited to prospective human studies from January 2005 to December 2011. The review compares the clinical conditions for which the AKI biomarkers have the greatest potential utility for the early detection of AKI. It also demonstrates the barriers to the successful use of AKI biomarkers in clinical practice, as well as the future trials that will be needed to validate their use. Despite the early promise of biomarkers such as neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18 for the early detection of AKI, none of these biomarkers has demonstrated a clear benefit in detecting various types of AKI in daily clinical practice. Indeed, the majority of published clinical studies of known AKI biomarkers so far are small and insufficient to support clinical studies of AKI biomarkers as an effective early AKI diagnostic test in humans.

Keywords: acute kidney injury, biomarker, early detection