The search for biomarkers and their evaluation by scientists and clinicians is of paramount importance if we are going to improve health care. In this paper we discuss the history of the discovery of biomarkers for renal and cardiac injury. We also summarize the use of biomarkers in preclinical evaluation in experimental animals and in patients to help diagnose or monitor a disease, predict outcome or to evaluate a therapeutic intervention. The need for validated biomarkers of tissue injury or disease that must be easy to analyse rapidly, preferably at the bedside, is essential if clinical decision making is to be optimally affected by their use.