No new biomarker of Acute Kidney Injury (AKI) has entered routine clinical practice after a decade of promise, although L-FABP, NGAL, and the combination of TIMP2 and IGFBY-7 are approved for use in some jurisdictions. Acceptance of creatinine as a surrogate of not just GFR but also renal injury, changes in nephrologist work loads, failure to establish the added value of each biomarker to current clinical variables across multiple clinical settings, the lack of treatment options, and simply an insufficient passage of time, have all contributed to the lack of progress. Future studies should establish reference intervals for biomarkers, associate biomarkers with meaningful clinical outcomes including mortality and development of Chronic Kidney Disease, and assess the added value to clinical models. The real value of biomarkers will be determined with intervention trials that use an elevated biomarker to triage to treatment. Ideally, such treatments will be linked directly to the physiological processes, which the biomarker identifies.
- Acute kidney injury
- Acute renal failure
- Copyright © 2016, American Journal of Physiology-Renal Physiology