Have biomarkers failed in acute kidney injury? No

McMahon, Blaithin A.; Koyner, Jay L.

doi:10.1007/s00134-017-4792-2

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…The above-mentioned examples clearly show that the biomarker universum is still under construction. Additionally, the ongoing discussion shows large discrepancies among scientists and clinicians regarding their accuracy and predictive value [ 24 , 25 , 26 ]. Yet, their diagnostic value is restricted to the short period between pre-AKI and AKI time points.…”

Section: Markers Of Injurymentioning

confidence: 99%

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Musiał

2021

JCM

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Pediatric acute kidney injury (AKI) is a major cause of morbidity and mortality in children undergoing interventional procedures. The review summarizes current classifications of AKI and acute kidney disease (AKD), as well as systematizes the knowledge on pathophysiology of kidney injury, with a special focus on renal functional reserve and tubuloglomerular feedback. The aim of this review is also to show the state-of-the-art in methods assessing risk and prognosis by discussing the potential role of risk stratification strategies, taking into account both glomerular function and clinical settings conditioned by fluid overload, urine output, or drug nephrotoxicity. The last task is to suggest careful assessment of eGFR as a surrogate marker of renal functional reserve and implementation of point-of-care testing, available in the case of biomarkers like NGAL and [IGFBP-7] × [TIMP-2] product, into everyday practice in patients at risk of AKI due to planned invasive procedures or treatment.

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Section: Markers Of Injurymentioning

confidence: 99%

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Musiał

2021

JCM

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“…The AKI biomarkers are also hampered by comparison against the current gold standard, creatinine. 72 Creatinine is an imperfect measure as described earlier. Because AKI is defined by a rise in creatinine; however, the performances of biomarkers are often inextricably linked to the performance of creatinine.…”

Section: Identification and Fda Approval Of Timp2*igfbp7 And Methodolmentioning

confidence: 99%

Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective

Griffin

Gist²,

Faubel

2019

J Intensive Care Med

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Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, and cost of care. Because of the high incidence and poor outcomes associated with AKI, there has been significant interest in the development of new therapies for the prevention and treatment of the disease. A lack of efficacy in drug trials led to the concern that AKI was not being diagnosed early enough for an effective intervention and that a rise in serum creatinine itself is not a sensitive-enough marker. Researchers have been searching for novel biomarkers that can not only assess a decline in kidney function but also demonstrate structural damage to the kidney and at time points earlier than increases in serum creatinine measurements allow. Over the past 10 years, there have been 3300 new publications and hundreds of new biomarkers investigated, yet concern still remains regarding AKI biomarker performance. The AKI biomarkers are yet to be widely utilized in clinical practice, leading some to question whether AKI biomarkers will ever reach their initial promise. However, we believe that biomarkers are an important part of current and future AKI research and clinical management. In this review, we compare the historical contexts of acute myocardial ischemia and AKI biomarker development to illustrate the progress that has been made within AKI biomarker research in a relatively short period of time and also to point out key differences between the disease processes that have been barriers to widespread AKI biomarker adoption. Finally, we discuss potential paths by which biomarkers can lead to appropriate AKI treatment responses that lower morbidity and mortality.

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“…In AKI substages, the concept of subclinical AKI (sub-AKI) emerges to designate an episode of AKI unrecognized due to the absence of oliguria or rise in serum creatinine (SCr) level, and AKI substages A and B arise in attempting to subcategorize AKI stages by the absence or presence of biomarkers [ 3 , 7 , 8 , 10 – 12 ]. However, there remains a gap between these recommendations and the clinical application, and whether elevation in biomarkers without any changes in SCr/oliguria or a change in SCr/oliguria without any change of damage biomarker is associated with worse kidney and patient outcomes remains elusive [ 7 , 8 , 13 – 15 ]. This is particularly true in children, because the results obtained in adults seem difficult to be transferred directly into the pediatric field, where the results and their interpretation are age-dependent [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children

Chen

Jiang

Huang

et al. 2023

Ann. Intensive Care

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Background The concept of acute kidney injury (AKI) substages has been recommended to better phenotype AKI and identify high-risk patient groups and therefore improve the diagnostic accuracy of AKI. However, there remains a gap between the recommendation and the clinical application. The study aimed to explore the incidence of AKI substages based on a sensitive AKI biomarker of urinary cystatin C (uCysC), and to determine whether AKI substages were relevant with respect to outcome in critically ill children. Results The multicenter cohort study enrolled 793 children in pediatric intensive care unit (PICU) of four tertiary hospitals in China. Children were classified as non-AKI, sub-AKI and AKI substages A and B according to uCysC level at PICU admission. Sub-AKI was defined by admission uCysC level ≥ 1.26 mg/g uCr in children not meeting the KDIGO criteria of AKI. In children who fulfilled KDIGO criteria, those with uCysC < 1.26 was defined as AKI substage A, and with ≥ 1.26 defined as AKI substage B. The associations of AKI substages with 30-day PICU mortality were assessed. 15.6% (124/793) of patients met the definition of sub-AKI. Of 180 (22.7%) patients with AKI, 90 (50%) had uCysC-positive AKI substage B and were more likely to have classical AKI stage 3, compared to substage A. Compared to non-AKI, sub-AKI and AKI substages A and B were risk factors significantly associated with mortality, and the association of sub-AKI (adjusted hazard ratio HR = 2.42) and AKI substage B (adjusted HR = 2.83) with mortality remained significant after adjustment for confounders. Moreover, AKI substage B had increased risks of death as compared with sub-AKI (HR = 3.10) and AKI substage A (HR = 3.19). Conclusions Sub-AKI defined/based on uCysC occurred in 20.2% of patients without AKI and was associated with a risk of death close to patients with AKI substage A. Urinary CysC-positive AKI substage B occurred in 50% of AKI patients and was more likely to have classical AKI stage 3 and was associated with the highest risk of mortality.

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Have biomarkers failed in acute kidney injury? No

Cited by 6 publications

References 16 publications

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective

The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children

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