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Table of Contents
Vol. 28, No. 3, 2009
Issue release date: October 2009
Section title: In-Depth Review
Free Access
Blood Purif 2009;28:165–174
(DOI:10.1159/000227785)

Early Diagnosis of Acute Kidney Injury: The Promise of Novel Biomarkers

Soni S.S.a, b, e · Ronco C.a, c · Katz N.d · Cruz D.N.a, c
aSan Bortolo Hospital, Vicenza, Italy; bMediciti Hospitals, Hyderabad, India; cInternational Renal Research Institute, Vicenza, Italy; dDepartment of Surgery, George Washington University, Washington, D.C., USA; e Seth Nandlal Dhoot Hospital, Aurangabad, India
email Corresponding Author

Abstract

The incidence of acute kidney injury (AKI) formerly referred to as acute renal failure (ARF) is increasing to epidemic proportions. Development of AKI portends excessive morbidity and mortality. AKI is associated with prolonged hospital stay, increased healthcare costs and high mortality especially in critically ill patients. The mortality rate has remained largely unchanged for many decades. Delay in the diagnosis of AKI using conventional biomarkers like urine output and serum creatinine has been one of the important obstacles in applying effective early interventions. Several new biomarkers are being evaluated in a quest for early diagnosis of AKI, among which neutrophil gelatinase-associated lipocalin (NGAL) appears to be one of the most promising. This review summarizes the recent literature on these biomarkers.

© 2009 S. Karger AG, Basel


  

Key Words

  • Acute renal failure
  • Acute kidney injury
  • Acute Kidney Injury Network (AKIN)
  • RIFLE Classification
  • Neutrophil gelatinase-associated lipocalin

References

  1. Smith H: The Kidney: Structure and Function in Health and Disease. London, Oxford University Press, 1964.
  2. Lameire N, Van Biesen W, Vanholder R: Acute renal failure. Lancet 2005;365:417–430.
  3. Kellum JA, Levin N, Bouman C, Lameire N: Developing a consensus classification system for acute renal failure. Curr Opin Crit Care 2002;8:509–514.
  4. Bellomo R, Kellum J, Ronco C: Acute renal failure: time for consensus. Intensive Care Med 2001;27:1685–1688.
  5. Bellomo R Ronco C, Kellum JA, the ADQI Workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–R212.
  6. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: Rifle criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
  7. Hoste EA, Kellum JA: Rifle criteria provide robust assessment of kidney dysfunction and correlate with hospital mortality. Crit Care Med 2006;34:2016–2017.
  8. Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C: North-East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEIPHROS-AKI): targeting the problem with the rifle criteria. Clin J Am Soc Nephrol 2007;2:418–425.
  9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
  10. Lopes JA, Fernandes P, Jorge S, Goncalves S, Alvarez A, Costa e Silva Z, Franca C, Prata MM: Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care 2008;12:R110.
  11. Bagshaw SM, George C, Bellomo R: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569–1574.
  12. Devarajan P: Emerging biomarkers of acute kidney injury. Contrib Nephrol. Basel, Karger, 2007, vol 156, pp 203–212.
  13. Feest TG, Round A, Hamad S: Incidence of severe acute renal failure in adults: results of a community-based study. BMJ 1993;306:481–483.
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    External Resources

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  60. Schmidt-Ott KM, Mori K, Kalandadze A, Li JY, Paragas N, Nicholas T, Devarajan P, Barasch J: Neutrophil gelatinase-associated lipocalin-mediated iron traffic in kidney epithelia. Curr Opin Nephrol Hypertens 2006;15:442–449.
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Author Contacts

Dr. Dinna N. Cruz
Nephrology Dialysis and Transplantation, San Bortolo Hospital
Via Rodolfi, 37, IT–36100 Vicenza (Italy)
Tel. +39 0444 753 650, Fax +39 0444 753 949
E-Mail dinnacruzmd@yahoo.com

  

Article Information

S.S. Soni is supported by a fellowship grant from the International Society of Nephrology.

Published online: July 8, 2009
Number of Print Pages : 10
Number of Figures : 0, Number of Tables : 3, Number of References : 93

  

Publication Details

Blood Purification

Vol. 28, No. 3, Year 2009 (Cover Date: October 2009)

Journal Editor: Ronco C. (Vicenza)
ISSN: 0253-5068 (Print), eISSN: 1421-9735 (Online)

For additional information: http://www.karger.com/BPU


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

The incidence of acute kidney injury (AKI) formerly referred to as acute renal failure (ARF) is increasing to epidemic proportions. Development of AKI portends excessive morbidity and mortality. AKI is associated with prolonged hospital stay, increased healthcare costs and high mortality especially in critically ill patients. The mortality rate has remained largely unchanged for many decades. Delay in the diagnosis of AKI using conventional biomarkers like urine output and serum creatinine has been one of the important obstacles in applying effective early interventions. Several new biomarkers are being evaluated in a quest for early diagnosis of AKI, among which neutrophil gelatinase-associated lipocalin (NGAL) appears to be one of the most promising. This review summarizes the recent literature on these biomarkers.

© 2009 S. Karger AG, Basel


  

Author Contacts

Dr. Dinna N. Cruz
Nephrology Dialysis and Transplantation, San Bortolo Hospital
Via Rodolfi, 37, IT–36100 Vicenza (Italy)
Tel. +39 0444 753 650, Fax +39 0444 753 949
E-Mail dinnacruzmd@yahoo.com

  

Article Information

S.S. Soni is supported by a fellowship grant from the International Society of Nephrology.

Published online: July 8, 2009
Number of Print Pages : 10
Number of Figures : 0, Number of Tables : 3, Number of References : 93

  

Publication Details

Blood Purification

Vol. 28, No. 3, Year 2009 (Cover Date: October 2009)

Journal Editor: Ronco C. (Vicenza)
ISSN: 0253-5068 (Print), eISSN: 1421-9735 (Online)

For additional information: http://www.karger.com/BPU


Article / Publication Details

First-Page Preview
Abstract of In-Depth Review

Published online: 7/8/2009
Issue release date: October 2009

Number of Print Pages: 10
Number of Figures: 0
Number of Tables: 3

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: http://www.karger.com/BPU


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Smith H: The Kidney: Structure and Function in Health and Disease. London, Oxford University Press, 1964.
  2. Lameire N, Van Biesen W, Vanholder R: Acute renal failure. Lancet 2005;365:417–430.
  3. Kellum JA, Levin N, Bouman C, Lameire N: Developing a consensus classification system for acute renal failure. Curr Opin Crit Care 2002;8:509–514.
  4. Bellomo R, Kellum J, Ronco C: Acute renal failure: time for consensus. Intensive Care Med 2001;27:1685–1688.
  5. Bellomo R Ronco C, Kellum JA, the ADQI Workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–R212.
  6. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: Rifle criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
  7. Hoste EA, Kellum JA: Rifle criteria provide robust assessment of kidney dysfunction and correlate with hospital mortality. Crit Care Med 2006;34:2016–2017.
  8. Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C: North-East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEIPHROS-AKI): targeting the problem with the rifle criteria. Clin J Am Soc Nephrol 2007;2:418–425.
  9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
  10. Lopes JA, Fernandes P, Jorge S, Goncalves S, Alvarez A, Costa e Silva Z, Franca C, Prata MM: Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care 2008;12:R110.
  11. Bagshaw SM, George C, Bellomo R: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569–1574.
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