Urinary, Plasma, and Serum Biomarkers’ Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis

Ho, Julie; Tangri, Navdeep; Komenda, Paul; Kaushal, Alka; Sood, Manish M.; Brar, Ranveer; Gill, K; Walker, Simon; Macdonald, Kerry; Hiebert, Brett; Arora, Rakesh C.; Rigatto, Claudio

doi:10.1053/j.ajkd.2015.06.018

Cited by 221 publications

(193 citation statements)

References 54 publications

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“…A recent meta-analysis by Ho et al including 16 studies with a total of 2906 patients investigated urine NGAL as a biomarker for the prediction of AKI after cardiac surgery in adult patients. The composite area under the receiver operating characteristic curve (AUC) of urine NGAL was 0.72 [23]. A recent study of patients with preeclampsia showed that measurement of NGAL was not a suitable diagnostic test for AKI [25].…”

Section: Biomarkers Of Akimentioning

confidence: 99%

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Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Kashani

Cheungpasitporn

Ronco

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

237

197

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Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.

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Section: Biomarkers Of Akimentioning

confidence: 99%

“…Furthermore, biomarkers 0. 72 Cardiac surgery in adults [23] 0.75 ICU [30] IL-18 A 24-kDa cytokine from the IL-1 family of cytokines (regulates innate and adaptive immunity) 0.64 Emergency department [20] No certain prediction of AKI in adults [10] 0.82 Pediatric cardiac surgery [31] 0.59…”

Section: Introductionmentioning

confidence: 99%

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Kashani

Cheungpasitporn

Ronco

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

237

197

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“…Urinary L-FABP can predict the onset of AKI after cardiac surgery [13,49,50], pediatric cardiopulmonary bypass [17], stem cell transplantation [12], and endovascular and open-abdominal aortic aneurysm repair [16] as well as in intensive care unit populations [15]. Additionally, L-FABP can also predict the progression to end-stage renal disease (ESRD), the onset of cardiovascular disease (CVD), or death for patients with AKI [14,51], type 2 diabetes [8,52], or chronic kidney a b Fig.…”

Section: Predicting Poor Outcomesmentioning

confidence: 99%

Urinary excretion of liver-type fatty acid-binding protein reflects the severity of sepsis

et al. 2017

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Sepsis due to microbial invasion often causes multiple organ failure (MOF), including acute kidney injury (AKI), with high mortality rates in serious cases. Hence, there is an urgent need for diagnostic biomarkers that can be used to rapidly, accurately, and easily detect sepsis to identify the condition early and guide the selection of appropriate treatment. Liver-type fatty acid-binding protein (L-FABP), which localizes in renal proximal tubules, is excreted into the urine in response to oxidative stress-induced tubular injury. Because of this mechanism, L-FABP has been reported to be a useful urinary biomarker not only for renal disease but also for the severity of sepsis. Based on this concept, we developed a new L-FABP point-of-care (POC) assay kit that can be used to rapidly measure human L-FABP in the urine to further improve the usefulness of this biomarker in clinical settings. In this review, we describe the molecular mechanisms of L-FABP, its clinical usefulness, and the performance of the POC assay kit.

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“…Both functional biomarkers and markers of injury have been identified which detect subclinical insult or facilitate the diagnosis of AKI early [6]. Unfortunately, following initial enthusiasm, it has become clear that most biomarkers have important shortcomings and limited utility at the bedside [7,8]. There are several potential explanations for their disappointing performance in clinical studies, including lack of a gold standard to define AKI, inclusion of patients with already overt AKI and absence of relevant patient outcomes.…”

Section: Predicting Akimentioning

confidence: 99%

Predictions are difficult…especially about AKI

2017

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Urinary, Plasma, and Serum Biomarkers’ Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis

Abstract: In adults, known urinary, plasma, and serum biomarkers of AKI possess modest discrimination at best when measured within 24 hours of cardiac surgery.

Cited by 221 publications

References 54 publications

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Urinary excretion of liver-type fatty acid-binding protein reflects the severity of sepsis

Predictions are difficult…especially about AKI

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