Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

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Figure 1.
Biomarkers of AKI: anatomic site along the nephron. This figure summarizes the biomarkers of AKI discussed in this paper and stratifies them according to their anatomic site of action. Biomarkers found in the blood are accounted for at the glomerulus and stratified as biomarkers of functional, structural, or ischemic renal injury. Urinary biomarkers are mapped along the nephron and stratified as biomarkers of functional or structural renal tubular injury.
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Figure 2.
Clinical timeline of biomarker risk stratification in cardiac surgery. This figure summarizes the findings to date of the Translational Research Investigating Biomarker Endpoints in AKI study (TRIBE AKI) Consortium with regards to the performance of biomarkers after adult and pediatric cardiac surgery. A variety of biomarkers were interrogated at several clinically relevant time points to determine their ability to prognosticate AKI outcomes. The outcomes that the biomarkers predict are given as bullets below each biomarker. The cohorts are given in parenthesis.

Table 1.

Biomarker performance from multicenter studies at a variety of clinical time points in cardiac surgery and critical illness

	Cardiac Surgery			Critical Illness/Sepsis
	Preop AKI Risk Assessment	Early Postop Diagnosis of AKI	AKI Progression	Early Diagnosis of AKI	Classification of AKI (Transient Versus Intrinsic AKI)	Prediction of Dialysis
U NGAL	N/A	+	−	+	+	+
B NGAL	−	+	+	−	?	−
U CysC	N/A	−	−	+	+	+
U IL-18	N/A	+	+	+	+	+
U KIM-1^a	N/A	+	−	+	−	−
U protein/albumin	+	+	+	?	?	?

Preop, preoperative; postop, postoperative; NGAL, neutrophil gelatinase-associated lipocalin; N/A, not applicable (biomarkers of tubular injury have no role in preoperative risk screening); +, data published displays the ability to detect this aspect of AKI; −, data published does not display the ability to detect this aspect of AKI; ?, no large multicenter data published on this biomarker/aspect of AKI; B, blood CysC, cystatin C; KIM-1, kidney injury molecule-1; U, urine.
↵^aKIM-1 data from the TRIBE-AKI study are under review.