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Role of Biomarkers in Predicting AKI in the CT ICU

  • Jay L. KoynerEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Acute kidney injury (AKI) is one of the most common complications following cardiothoracic surgery and is independently associated with increased morbidity and mortality. Serum creatinine and urine output, the current gold standards, do not provide effective early risk stratification which has led to intense investigation of several novel biomarkers of AKI. This chapter will discuss the literature around pre and post-operative biomarkers of cardiothoracic surgery associated AKI focusing on several novel assays including Neutrophil Gelatinase Associated Lipocalin (NGAL) and Tissue injury metalloprotease-2 insulin-like growth factor binding protein-7 (TIMP2-IGFBP7). We discuss the wealth of prospective observational data that demonstrates these biomarkers can accurately detect AKI and the need for renal replacement therapy earlier than serum creatinine. Additionally, we will discuss the clinical utility and interpretation of these tests as well as discuss the limited randomized data demonstrates that utilizing elevated post-operative biomarkers, prior to a rise in serum creatinine, to trigger a nephrology-focused care bundle can improve outcomes following cardiac surgery.

Keywords

Acute kidney injury Biomarkers Renal replacement therapy Cardio-thoracic surgery Neutrophil gelatinase associated lipocalin (NGAL) Tissue injury metalloprotease-2 insulin-like growth factor binding protein-7 (TIMP2-IGFBP7) 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Section of Nephrology, Department of MedicineUniversity of ChicagoChicagoUSA

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