Biomarkers of Acute Kidney Injury after Cardiac Surgery: A Narrative Review

Abstract

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major and serious complication in patients undergoing cardiac surgery and is independently associated with perioperative mortality and mortality. Therapeutic intervention aiming at reversing kidney dysfunction seems disappointing across multiple settings. Consequently, attention has shifted from treatment to prevention and early detection. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines have unified diagnostic standards mainly based on the serum creatinine (Scr) level or urine output, but neither marker is kidney specific. Efforts have been made to identify novel biomarkers with high sensitivity and specificity. The diagnostic capabilities of neutrophil gelatinase-associated lipocalin (NGAL) and G1 cell cycle arrest biomarker as biomarkers have been confirmed in a large number of clinical trials. The utility of biomarkers of cardiac function and inflammation has been validated in clinical studies. Aiming to offer valuable information for further research, we summarize the progress in defining current markers relevant to CSA-AKI in the last three years.

Serum Anion Gap Predicts All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury: Analysis of the MIMIC-III Database

“…In the presence of AKI, patient mortality within 1 year after ICU admission is significantly elevated, as high as 60%-70% [4,5]. Because of the high incidence and poor prognosis of AKI in critically ill patients, researchers are attempting to identify prognostic predictors in AKI [6,7]. Unfortunately, most of them are not widely used in clinical practice.…”

Biomarker evidence for distal tubular damage but cortical sparing in hospitalized diabetic patients with acute kidney injury (AKI) while on SGLT2 inhibitors

“…The overlapping uNGAL in the two groups of patients is especially prominent in Figure 3(B), where 'normal' urine NGAL levels are more clustered. uNGAL physiologically should better predict distal tubular injury since its majority comes from the distal nephron, whereas sNGAL also reflects diminished renal clearance of NGAL originated in non-renal tissues [17,41]. Unfortunately, urinalysis, a most important diagnostic tool for the detection of ATI [42] has not been utilized in most patients, and its correlation with the biomarkers could not be tested.…”

New trends in the study of post-transplant acute kidney injury after liver transplantation

“…Новым трендом в ранней диагностике различных заболеваний, в том числе у пациентов после трансплантации солидных органов, является поиск и изучение для этой цели различных биомаркеров [61,62]. Хотя уровень креатинина в сыворотке крови пока остается «золотым стандартом» оценки функции почек, этот тест имеет низкую специфичность и чувствительность для ранней диагностики ОПП [63]. Поэтому, а также в связи с тем, что современная терапия ОПП оставляет желать лучшего, в настоящее время внимание исследователей акцентируется не на методах лечения, а на профилактике и раннем выявлении ОПП у тяжелых пациентов, в том числе и у больных после ТП [64,65].…”

“…Диагностические возможности липокалина, ассоциированного с нейтрофильной желатиназой (NGAL), и биомаркера остановки клеточного цикла G1 были подтверждены в большом количестве клинических исследований кардиохирургических больных (B. Wu et al, 2019) [63]. Для предсказания ОПП после ТП также было предложено определять NGAL (A.C.Y.…”