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Am J Kidney Dis. 2016 Jul;68(1):19-28. doi: 10.1053/j.ajkd.2015.12.033. Epub 2016 Mar 4.

Clinical Use of the Urine Biomarker [TIMP-2] × [IGFBP7] for Acute Kidney Injury Risk Assessment.

Author information

1
Renal Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO. Electronic address: avijayan@dom.wustl.edu.
2
Renal Division, University of Colorado Denver and Denver VA Medical Center, Denver, CO.
3
Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL.
4
Albany Medical College, Albany, NY.
5
Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, TN.
6
Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
7
Renal Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO.
8
Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL.
9
Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Anesthesia, University of California, San Francisco, San Francisco, CA.
10
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
11
Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA.
12
Department of Medicine, University of Florida, Gainesville, FL; Department of Anesthesiology, University of Florida, Gainesville, FL; Department of Surgery, University of Florida, Gainesville, FL.

Abstract

Acute kidney injury (AKI) is a serious complication, commonly occurring in the critically ill population, with devastating short- and long-term consequences. Despite standardization of the definition and staging of AKI, early recognition remains challenging given that serum creatinine level is a marker, albeit imperfect, of kidney function and not kidney injury. Furthermore, the delay in increase in serum creatinine level after loss of glomerular filtration also prevents timely detection of decreased kidney function in patients with AKI. During the past decade, numerous clinical investigations have evaluated the utility of several biomarkers in the early diagnosis and risk stratification of AKI. In 2014, the US Food and Drug Administration approved the marketing of a test based on the combination of urine concentrations of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 ([TIMP-2] × [IGFBP7]) to determine whether certain critically ill patients are at risk for developing moderate to severe AKI. The optimal role of this biomarker in the diagnosis, management, and prognosis of AKI in different clinical settings requires further clarification. In this perspective, we summarize the biological actions of these 2 cell-cycle arrest biomarkers and present important considerations regarding the clinical application, interpretation, and limitations of this novel test for the early detection of AKI.

KEYWORDS:

Acute kidney injury (AKI); NephroCheck; [TIMP-2] × [IGFBP7]; biomarker; critically ill; decreased kidney function; diagnosis; early detection; insulin-like growth factor binding protein 7; renal dysfunction; risk assessment; tissue inhibitor of metalloproteinase 2

PMID:
26948834
PMCID:
PMC4921267
DOI:
10.1053/j.ajkd.2015.12.033
[Indexed for MEDLINE]
Free PMC Article

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