<p>Evaluating Nephrocheck^® as a Predictive Tool for Acute Kidney Injury</p>

Abstract

Acute kidney injury (AKI) is a common complication in critically ill patients in the intensive settings with increased risks of short-and long-term complications and mortality. AKI is also associated with an increased length of stay in intensive care units (ICU) and worse kidney function recovery at hospital discharge. The management of AKI is one of the major challenges for nephrologists and intensivists overall for its early diagnosis. The current KDIGO criteria used to define AKI include the serum creatinine and urinary output that are neither sensitive nor specific markers of kidney function, since they can be altered only after hours from the kidney injury. In order to allow an early AKI detection, in the last years, several studies focused on the identification of new biomarkers. Among all these markers, urinary insulin-like growth factor-binding protein (IGFBP-7) and tissue inhibitor of metalloproteinase (TIMP-2) have been proven as the best-performing and have been proposed as a predictive tool for the AKI detection in the critical settings in order to perform an early diagnosis. Patients undergoing major surgery, cardiac surgery, those with hemodynamic instability or those with sepsis are believed to be the top priority patient populations for the biomarker test. In this view, the urinary [TIMP-2] x [IGFBP-7] becomes an important tool for the early detection of patients at high risk for AKI and its integration with the local ICU experience has to provide a multidisciplinary management of AKI with the institution of a rapid response team in order to assess patients and customize AKI management.

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

“…Moreover, similarly to NGAL, [IGFBP-7] × [TIMP-2] is now available in the form of a point-of-care test, Nephrocheck. Nalesso et al [ 23 ] have analyzed the usefulness of Nephrocheck based on the literature analysis. The authors concluded that the use of this test should be considered in the case of any large surgery or when invasive procedure is planned.…”

“…The major restriction is the fact that the predictive value of [IGFBP-7] × [TIMP-2] product increases with the severity of patient condition. In practice, the marker distinguishes quite precisely between those who develop severe AKI and no AKI, but copes rather poorly with the prediction of mild forms of AKI [ 23 ].…”

The Impact of The [TIMP-2] × [IGFBP7]-Guided Checklist for Early Recognition and Treatment of Acute Illness on The Prevention of Acute Kidney Injury In Patients With Septic Shock

“…Urinary [TIMP-2] and [IGFBP7] are two markers of renal tubule injury involved in G1 cell cycle arrest. These two newer stress and damage biomarkers have shown good performance for the early detection of AKI [6]. Due to their strong performance, we used these biomarkers to screen sepsis patients to determine which patients were at a high risk for AKI and needed bundled care.…”

The kidney: function, cells and biomarkers

“…With this publication, Tavares et al stimulate new investigations on the subject to be done with NGAL, KIM-1 and the other molecules. Second generation biomarkers, TIMP-2 and IGFBP-7, 7 which reflect the cell-cycle interruption of cells in the proximal and distal tubular epithelium, will probably be tested. Some of them detect cell insults, 7 , 8 including sublethal ones, from clinical or surgical stress, even in the first 12 hours, as they are also used to identify the persistence of AKI epithelial lesion in AKIN 2 and 3 stages.…”

“…Second generation biomarkers, TIMP-2 and IGFBP-7, 7 which reflect the cell-cycle interruption of cells in the proximal and distal tubular epithelium, will probably be tested. Some of them detect cell insults, 7 , 8 including sublethal ones, from clinical or surgical stress, even in the first 12 hours, as they are also used to identify the persistence of AKI epithelial lesion in AKIN 2 and 3 stages. 9 The promising expectation is that, in the near future, these biomarkers will consolidate as tools for risk stratification and severity in AKI, as well as for the definition of personalized clinical procedures, including in glomerulopathies.…”