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Open Access Highly Accessed Review

Biomarkers for early diagnosis of AKI in the ICU: ready for prime time use at the bedside?

Patrick M Honore15*, Rita Jacobs1, Olivier Joannes-Boyau2, Lies Verfaillie1, Jouke De Regt1, Viola Van Gorp1, Elisabeth De Waele1, Willem Boer3, Vincent Collin4 and Herbert D Spapen1

Author Affiliations

1 Intensive Care Dept, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium

2 Haut Leveque University Hospital of Bordeaux, University of Bordeaux 2, Pessac, France

3 Department of Anaesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium

4 Cliniques de l’Europe-Site St Michel, Brussels, Belgium

5 Critical Care Nephrology Platform, Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090, Brussels, Belgium

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Annals of Intensive Care 2012, 2:24  doi:10.1186/2110-5820-2-24

Published: 2 July 2012

Abstract

Because of its still rising incidence and high mortality rate in intensive care unit (ICU) patients, early recognition of acute kidney injury (AKI) remains a critical issue. Surprisingly, effective biomarkers for early detection and hence appropriate and timely therapy of AKI have not yet entered the clinical arena. We performed a systematic search of the literature published between 1999 and 2011 on potential early biomarkers for acute renal failure/kidney injury in an at-risk adult and pediatric population following the Quorum Guidelines. Based on this review, recommendations for the clinical use of these biomarkers were proposed. In general, kidney biomarkers may aid to direct early aggressive treatment strategies for AKI thereby decreasing the associated high mortality. To date, however, sensitivity and specificity of individual biomarker assays are low and do not sustain their routine clinical use. “Kits” containing a combination of established biomarkers, in conjunction with measured glomerular filtration rate, may enhance diagnostic and prognostic accuracy in the future.

Keywords:
Hemofiltration; Biomarkers; Early diagnosis; Sepsis; Septic shock; SIRS, Acute kidney injury; Acute tubular apoptosis; Sepsis modulation; Blood purification; Dialysis; CRRT; Review