Acute Kidney Injury in the Icu: Time Has Come for an Early Biomarker Kit!

Abstract

Early recognition of acute kidney injury (AKI) in the intensive care unit (ICU) remains a critical problem, with a rising incidence and a high mortality rate. As a consequence, the actual lack of an early and effective biomarker results in a significant delay in initiating appropriate therapy. The accurate diagnosis of AKI is especially problematic in critically-ill patients, in whom we know that renal function is in an unsteady state; therefore the validity of creatinine-based baseline assessment measures is reduced. Because the rationale for assessing AKI markers in critically-ill patients is strong at the present time, researchers are stimulated to establish a multidimensional AKI classification system. This system should in essence grade AKI severity. The most widely referenced classification is the RIFLE system. Thus, early recognition of AKI, well before changes in serum creatinine occur, has come under intensive research, because it is evidenced that even small increases in serum creatinine are associated with an increase in patient mortality. The development of a biomarker kit in which several early markers with different characteristics are combined, is essential. Multi-centre, randomized studies indicate a potential for early biomarkers able to diagnose AKI 48 hours before creatinine changes. In conclusion, time has come to leave serum creatinine behind as a marker of renal function in patients with AKI on the ICU. Only then will we be able to offer early goal-directed therapy for the kidney in the ICU setting.

Urinary Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor-Binding Protein 7 for Risk Stratification of Acute Kidney Injury in Patients With Sepsis

“…Thus, clinicians can rely on these biomarkers for predicting AKI even in the presence of nonrenal organ failures. This is a notable advance in comparison with other biomarkers that are available around the world (39–42). …”

“…In terms of timing, this signal could be ideal as it may be early enough that management strategies can still alter the outcome. This is particularly important in septic AKI where delay and early timing remains a major issue (4, 32, 42). …”

Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases

“…The mortality rate of patients with crush syndrome could be as high as 50% to 70%. Crush syndrome can be diagnosed when a crush injury patient develops systemic manifestations such as shock, acidosis, and ARF [21-23]. …”

Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments

“…An early biomarker might have prognostic implications, given the immense impact of AKI-associated mortality on global disease-related mortality [33,34]. Unfortunately, all actually studied biomarkers have insufficient sensitivity to detect AKI in the ICU, and diagnostic power may only increase when a combination of various biomarkers is used, including cystatin-C, Neutrophil gelatinase-associated lipocalin (NGAL) in the serum and urine, IL-18, and kidney injury molecule 1 (KIM -1) [34-36]. …”