Current developments in early diagnosis of acute kidney injury

Int Urol Nephrol. 2014 Jan;46(1):1-7. doi: 10.1007/s11255-013-0448-5. Epub 2013 May 15.


Acute kidney injury (AKI) is a very frequent and serious clinical problem, accounting for overall high morbidity and mortality. Up to date, mortality due to AKI is virtually unchanged over the past 50 years. This may partly be explained due to a delay in initiating renal protective and appropriate therapeutic measures since until now there are no reliable early-detecting biomarkers. The gold standard, serum creatinine, displays poor specificity and sensitivity with regard to identification of the incipient phase of AKI, and this is also true for cystatin C. We aimed to review novel biomarkers of AKI in urine and serum which have now progressed to the clinical phase. The main focus refers to their diagnostic and prognostic value. For this purpose, a web-based literature search using PubMed was performed comprising the following terms: renal failure, acute kidney injury and biomarkers. New molecules such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), N-acetyl-β-D-glucosaminidase (NAG), monocyte chemotactic peptide (MCP-1), Il-18, liver-type fatty acid-binding protein (L-FABP) and Netrin-1 are available and represent promising new markers that, however, need to be further evaluated in the clinical setting for suitability. In clinical settings with incipient AKI, not only the development and the implementation of more sensitive, practicable and accurate biomarkers are required for well-timed treatment initiation. Just as important is a substantial improvement of refined and applicable prophylactic therapeutic options in these situations. Before full adoption in clinical practice can be accomplished, adequately powered clinical trials testing a row of biomarkers are strongly warranted.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / urine
  • Acute-Phase Proteins / urine
  • Biomarkers / blood
  • Biomarkers / urine
  • Chemokine CCL2 / genetics
  • Chemokine CCL2 / urine*
  • Early Diagnosis
  • Fatty Acid-Binding Proteins / urine
  • Hepatitis A Virus Cellular Receptor 1
  • Humans
  • Interleukin-18 / urine
  • Lipocalin-2
  • Lipocalins / blood*
  • Lipocalins / urine
  • Membrane Glycoproteins / genetics
  • Membrane Glycoproteins / urine*
  • Neoplasm Proteins / urine*
  • Nerve Growth Factors / urine
  • Netrin-1
  • Proto-Oncogene Proteins / blood*
  • Proto-Oncogene Proteins / urine
  • RNA, Messenger / urine*
  • Receptors, Virus / genetics
  • Tumor Suppressor Proteins / urine


  • Acute-Phase Proteins
  • Biomarkers
  • CCL2 protein, human
  • Chemokine CCL2
  • FABP1 protein, human
  • Fatty Acid-Binding Proteins
  • HAVCR1 protein, human
  • Hepatitis A Virus Cellular Receptor 1
  • Interleukin-18
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Membrane Glycoproteins
  • NBAS protein, human
  • NTN1 protein, human
  • Neoplasm Proteins
  • Nerve Growth Factors
  • Proto-Oncogene Proteins
  • RNA, Messenger
  • Receptors, Virus
  • Tumor Suppressor Proteins
  • Netrin-1