ADQI Consensus on AKI Biomarkers and Cardiorenal SyndromesEditor(s): McCullough P.A. (Novi, Mich.)
Kellum J.A. (Pittsburgh, Pa.)
Mehta R.L. (San Diego, Calif.)
Murray P.T. (Dublin)
Ronco C. (Vicenza)
Differential Diagnosis of AKI in Clinical Practice by Functional and Damage Biomarkers: Workgroup Statements from the Tenth Acute Dialysis Quality Initiative Consensus ConferenceEndre Z.H.a, b · Kellum J.A.c · Di Somma S.d · Doi K.e · Goldstein S.L.f · Koyner J.L.g · Macedo E.h · Mehta R.L.i · Murray P.T.j · for the ADQI 10 Workgroup
aDepartment of Nephrology, Prince of Wales Clinical School, University of New South Wales, Sydney, N.S.W., Australia; bChristchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand; cDepartment of Critical Care Medicine, School of Medicine, Pittsburgh, Pa., USA; dDepartment of Medical and Surgery Sciences and Translational Medicine, University La Sapienza, Rome, Italy; eDepartment of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan; fCenter for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; gSection of Nephrology, Prizker Shool of Medicine, University of Chicago, Chicago, Ill., USA; hDepartment of Internal Medicine, Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil; iUCSD Medical Centre University of California San Diego, San Diego, Calif., USA; jSchool of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Acute kidney injury (AKI) is a common but complex clinical syndrome with multiple etiologies. These etiologies target different sites and pathways within the kidney. Novel biomarkers of ‘kidney damage' (which can be tubular or glomerular) can be used to diagnose AKI, even in the absence of an increase in serum creatinine or oliguria. These biomarkers of kidney damage can be combined with biomarkers of kidney function to facilitate classification of AKI. A comprehensive review of the literature was performed using the published methodology of the Acute Dialysis Quality Initiative (ADQI) working group and used to establish consensus statements regarding the use of biomarkers in the differential diagnosis of AKI. We recommend that the pathophysiological terms ‘functional change' and ‘kidney damage' be used in preference to the anatomical classification using the terms pre-renal, renal and post-renal AKI. We further recommend the use of both renal and non-renal biomarkers in establishing the specific cause of AKI as soon as possible after diagnosis. The presence of underlying CKD or of sepsis poses additional challenges in differential diagnosis, since these conditions alter both baseline biomarker excretion and biomarker performance. We recommend that biomarkers be validated within the clinical context in which they are to be used. Within that context, combinations of biomarkers may, in the future, allow differentiation of the site, mechanism and phase of injury.
© 2013 S. Karger AG, Basel
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