John W Pickering1, Zoltán H Endre. 1. Christchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand.
Abstract
PURPOSE OF REVIEW: Secondary prevention follows identification of acute kidney injury (AKI), in which functional outcome is incomplete. Secondary prevention requires biomarkers for early diagnosis and response to appropriate treatment, on-going injury and repair, and meaningful metrics to monitor outcome. This review summarizes recent research in these areas. RECENT FINDINGS: Proteomics and genetic studies have identified new risk factors and biomarkers of AKI. Biomarker performance studies reveal differences in prognostic performance according to population and AKI definition. The first early secondary prevention study utilizing a urinary biomarker of AKI as a triaging tool to randomize to treatment has been completed. Recent creatinine-kinetic modelling has highlighted issues with defining AKI which continue to make comparison of treatment outcomes difficult. Biomarkers to monitor repair are emerging. SUMMARY: The prognostic performance of novel biomarkers of AKI in a range of clinical settings is encouraging and critical to effective secondary prevention. Identification of cause and time-course of specific biomarkers are required before biomarker panels for secondary prevention are developed. Agreed standards around reporting of biomarker studies would facilitate comparisons between studies. Phase-specific biomarkers are required to triage to phase-specific treatment.
PURPOSE OF REVIEW: Secondary prevention follows identification of acute kidney injury (AKI), in which functional outcome is incomplete. Secondary prevention requires biomarkers for early diagnosis and response to appropriate treatment, on-going injury and repair, and meaningful metrics to monitor outcome. This review summarizes recent research in these areas. RECENT FINDINGS: Proteomics and genetic studies have identified new risk factors and biomarkers of AKI. Biomarker performance studies reveal differences in prognostic performance according to population and AKI definition. The first early secondary prevention study utilizing a urinary biomarker of AKI as a triaging tool to randomize to treatment has been completed. Recent creatinine-kinetic modelling has highlighted issues with defining AKI which continue to make comparison of treatment outcomes difficult. Biomarkers to monitor repair are emerging. SUMMARY: The prognostic performance of novel biomarkers of AKI in a range of clinical settings is encouraging and critical to effective secondary prevention. Identification of cause and time-course of specific biomarkers are required before biomarker panels for secondary prevention are developed. Agreed standards around reporting of biomarker studies would facilitate comparisons between studies. Phase-specific biomarkers are required to triage to phase-specific treatment.
Authors: Zoltán H Endre; John W Pickering; Robert J Walker; Prasad Devarajan; Charles L Edelstein; Joseph V Bonventre; Christopher M Frampton; Michael R Bennett; Qing Ma; Venkata S Sabbisetti; Vishal S Vaidya; Angela M Walcher; Geoffrey M Shaw; Seton J Henderson; Maryam Nejat; John B W Schollum; Peter M George Journal: Kidney Int Date: 2011-02-09 Impact factor: 10.612
Authors: John W Pickering; Christopher M Frampton; Robert J Walker; Geoffrey M Shaw; Zoltán H Endre Journal: Crit Care Date: 2012-06-19 Impact factor: 9.097