Traditional and Novel Tools for Diagnosis of Acute Kidney Injury
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Diagnosis of acute kidney injury (AKI) is traditionally based on changes of serum creatinine (SCr) over time or compared to baseline. Oliguria, even without elevation in SCr, carries a prognostic significance. Including urine output in the definition of AKI increases the sensitivity of AKI diagnosis. SCr and urine output are considered functional markers of AKI. Novel biomarkers of AKI can be grouped into damage and stress biomarkers and may identify subclinical AKI. Damage biomarkers include neutrophil gelatinase-associated lipocalin [NGAL] and kidney injury molecule 1 [KIM-1] among others. Stress biomarkers include insulin-like growth factor-binding protein 7 [IGFBP7] and tissue inhibitor of metalloproteinases-2 [TIMP-2] and predict moderate to severe AKI better than previously described markers. Novel biomarkers are promising but have limited clinical application till this moment. Determining baseline SCr and differentiating between AKI and CKD can be challenging. Imaging techniques such as functional magnetic resonance imaging, real-time glomerular filtration rate measurement and contrast-enhanced ultrasonography have been applied for diagnosis of AKI but have limitations that preclude their use in the clinical setting.
KeywordsAcute kidney injury Diagnosis Biomarkers Renal imaging
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