Biomarkers for the diagnosis of acute kidney injury.
Nephron Clin Pract. 2008;109(4):c192-7
Authors: Waikar SS, Bonventre JV
The identification of acute kidney injury relies on tests like blood urea nitrogen and serum creatinine that were identified and incorporated into clinical practice several decades ago. This review summarizes clinical studies of newer biomarkers that may permit earlier and more accurate identification of acute kidney injury. The urine may contain sensitive and specific markers of kidney injury that are present due to either impaired tubular reabsorption and catabolism of filtered molecules or release of tubular cell proteins in response to ischemic or nephrotoxic injury. Many potential markers have been studied. Promising injury markers in the urine include N-acetyl-beta-D-glucosaminidase, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18. New biomarkers of kidney injury hold the promise of substantially improving the diagnostic approach to acute kidney injury. Adequately powered clinical studies of multiple biomarkers are needed to qualify the biomarkers before they can be fully adopted in clinical practice. Once adopted, more sensitive biomarkers of acute kidney injury hold the potential to transform the care of patients with renal disease.
PMID: 18802367 [PubMed - indexed for MEDLINE]
The ideal diagnosis of AKI may rest on the validation of emerging urinary and/or serum tissue injury biomarkers that do not suffer the drawbacks of glomerular filtration markers such as creatinine or cystatin C. If SCr is used as the diagnostic criterion for AKI, then we suggest that the definition proposed here may be well suited to the task.
NGAL.Neutrophil Gelatinase Associated Lipocalcin
KIM-1..Kidney Injury Molecule -1
Biomarker Detection Associated
1)KIM-1(kidney injury molecule-1 )–identified with ELISA/Luminex® useful in
2)NGAL(neutrophil gelatinase associated lipocalin (NGAL), – identified by ELISA/Luminex®- useful in
– Ischemic AKI,
3)-IL-18 identified by ELISA/Luminex®- useful in
4)-Cystatin C -identified by Nephelometry-
Reduced in GFR,
proximal tubule injury
several proteins emerged as sensitive and specific biomarkers with a capacity
to be used in the detection of early kidney injury and grading of injury severity. This issue
of Nephrology Rounds reviews four potentially tandem AKI biomarkers that have shown
promise in recent human studies:
N-NGAL-neutrophil gelatinase associated lipocalin (NGAL),
K-KIM-1kidney injury molecule-1 (KIM-1),
I- IL-18interleukin-18 (IL-18), and
C-Cystatin C (Cys-