Biomarkers for AKI after Major Surgery
Chirag Parikh, MD PhD (Yale University)
Dr. Parikh has done incredible work in the area of early AKI biomarkers. In fact, his work has been so influential in the field that he started the TRIBE-AKI Consortium – a group of physician-scientists (and their respective research teams) who are working to identify these early biomarkers. Creatinine remains the most common biomarker for kidney disease, but has many limitations that can only be overcome by identifying new biomarkers. For example, creatinine represents glomerular function, which isn’t very useful in AKI where there is much tubular injury that isn’t detected by creatinine. Creatinine takes 24-48h to increase *after* the initial insult, delaying our ability to detect AKI and intervene appropriately.
Given that the nephron is made from 3 embryologic structures, it isn’t surprising to Dr. Parikh that each segment of the tubule will have a different biomarker for detecting injury. An example of these biomarkers (of which some you’ve already heard) include IL-18, urinary and plasma NGAL, and KIM-1 (note this is not an exhaustive list). A recent trial by the TRIBE-AKI consortium looked at 1200 adults and 300 children who developed AKI to identify legitimate, non-creatinine biomarkers. They found that, in the adults, urine IL-18 and plasma NGAL were accurate markers for early AKI development (ROC AUC 0.74 and 0.70, respectively). In children, it was urine IL-18 and urine NGAL (ROC AUC 0.74 and 0.67, respectively).
The work continues in identifying these biomarkers. Stay tuned for more information in the coming months.