Acute Kidney Injury In Emergency Cases - Using Biomarkers

Editor's Choice
Academic Journal
Main Category: Urology / Nephrology
Also Included In: Cardiovascular / Cardiology
Article Date: 12 Jan 2012 - 6:00 PST

email to a friend   printer friendly   opinions  

A study published online in the Journal of the American College of Cardiology reports that researchers have discovered a new approach for diagnosing acute kidney injury (AKI), which has severe consequences with a 25 to 80% risk of in-hospital death, that allows emergency departments to identify high-risk patients on admission.

To determine kidney function, physicians commonly measure patients' creatinine levels, however, these levels can remain normal for several hours following acute kidney damage. In order to achieve a precise assessment, physicians need to take measurements over a one to three day period, which limits the use in an emergency room.

Thomas Nickolas, MD, MS, assistant professor of clinical medicine at Columbia University College of Physicians and Surgeons and a kidney specialist at New York-Presbyterian Hospital/The Allen Hospital explains that in contrast, urinary biomarkers only take approximately half an hour for obtaining a measure of the severity of kidney damage.

In an international multi-center collaboration at the New York-Presbyterian Hospital/Columbia University Medical Center, the Staten Island University Hospital, the Charité-Universitätsmedizin, the Max Delbruck Center for Molecular Medicine, and Helios Clinics in Berlin, Germany, researchers evaluated the new approach for the diagnosis of acute kidney injury.

They obtained a single measure of five urinary biomarkers from 1,635 emergency room patients upon hospital admission. The researchers noted that even though all five biomarkers were elevated in incidents of intrinsic AKI (iAKI), the most severe form of AKI, the biomarker called uNGAL was most precise in diagnosing iAKI.

It was also the biomarker, which best predicted the duration and severity of the injury. Both uNGAL and another biomarker, named Kim-1 were reported to be the most accurate biomarkers in predicting death or the need to initiate dialysis during hospitalization. The biomarker uNGAL was identified at the New York-Presbyterian Hospital/Columbia University Medical Center and at Cincinnati Children's Hospital. In this study, researchers measured uNGAL by Abbott's ARCHITECT-NGAL assay, which can be obtained commercially outside the US.

Senior researcher Jonathan Barasch, MD, PhD, associate professor of medicine and of anatomy and cell biology at the Columbia University College of Physicians and Surgeons, who is also a kidney specialist at the New York-Presbyterian Hospital/The Allen Hospital declared:

"The ability to identify acute kidney damage while the patient is in triage is especially important in busy urban hospitals, where patients cannot wait for repetitive measures of creatinine and are frequently lost to follow-up. The use of urinary biomarkers could also be of great use to the military, at disaster sites, and in other situations where quick medical decisions must be made."

Dr. Kai Schmidt-Ott, MD, a kidney specialist at the Charité Berlin and research group leader at the Max Delbrück Center for Molecular Medicine, who is also adjunct assistant professor at Columbia University Medical Center added:

"Combining urinary biomarkers such as uNGAL with the current standard marker creatinine will significantly improve the identification of patients at risk of death or dialysis in the hospital. Identifying these patients at the earliest possible time in the emergency room may enable us to introduce new treatment options to improve their outcomes."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations