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Managing Renal Injury in the Elderly Patient pp 19–32Cite as

Risk Assessment and Diagnostic Criteria of Acute Kidney Injury: The Role of Tubular Damage Markers

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Abstract

Acute kidney injury (AKI) is a frequent complication in hospitalized patients, especially in the older ones, and associated with substantially increased morbidity and mortality. Diagnosis of AKI is frequently delayed, at least in part, resulting from currently used diagnosis parameters basing on renal filtration function such as serum creatinine and urine output. Such delay may be further pronounced in sicker and older patients. Delayed AKI diagnosis may also contribute to no available effective intervention to prevent or successfully treat AKI because at the time of diagnosis of established AKI, irreversible organ damage may already have occurred. The recently published, international, multidisciplinary clinical practice guidelines for AKI has recommended clinicians to carry out careful renal risk assessment and highlighted the importance of such assessment for individual patient management. Accordingly, several acute tubular damage markers (mostly urine proteins) have been subjected to rigorous clinical testing for their ability to estimate renal risk or to early diagnose AKI, including neutrophil gelatinase-associated lipocalin (NGAL), cell cycle arrest-inducing markers, interleukin-18, liver-type fatty acid-binding protein, and kidney injury molecule-1 (KIM-1). Within a few hours after renal insult, such tubular damage markers are detected in urine and plasma which is usually 24–48 h prior to renal functional marker-based AKI diagnosis. Available data from experimental and clinical studies suggests acute tubular markers being valuable for risk assessment and early diagnosis of AKI of diverse etiology. Acute tubular damage biomarkers may guide earlier initiation of nephroprotection, improved fluid management, or withdrawal of nephrotoxins directed at improvement of outcomes in patients developing AKI. The Acute Dialysis Quality Initiative has now recommended the use of such markers of tubular damage for AKI diagnosis complementary to renal function markers.

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  1. Department of Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital, Otto-von-Guericke University, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany

    Michael Haase MD (MH) & Anja Haase-Fielitz PharmD (AHF)

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  1. Michael Haase MD (MH)
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  2. Anja Haase-Fielitz PharmD (AHF)
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Correspondence to Michael Haase MD (MH) .

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  1. Dep. of Nephrology and Hypertension, Otto von Guericke University Magdeburg, Magdeburg, Germany

    Michael Haase

  2. Dep. of Nephrology and Hypertension, Otto von Guericke University Magdeburg, Magdeburg, Germany

    Anja Haase-Fielitz

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Haase, M., Haase-Fielitz, A. (2014). Risk Assessment and Diagnostic Criteria of Acute Kidney Injury: The Role of Tubular Damage Markers. In: Haase, M., Haase-Fielitz, A. (eds) Managing Renal Injury in the Elderly Patient. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39947-3_4

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  • DOI: https://doi.org/10.1007/978-3-642-39947-3_4

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