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  • Review Article
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Technology Insight: biomarker development in acute kidney injury—what can we anticipate?

Nature Clinical Practice Nephrology volume 4, pages 154–165 (2008)Cite this article

Abstract

Early diagnosis has been the 'Achilles heel' of acute kidney injury (AKI) that has prevented successful implementation of treatment strategies. To date, pharmacological intervention has been largely unsuccessful or equivocal, and morbidity and mortality associated with AKI have remained unacceptably high. Despite their well-known limitations, the most widely used biomarkers for the early diagnosis of AKI are serum creatinine, blood urea nitrogen and urine output. Development of new biomarkers is imperative. A variety of methods have been employed to discover new biomarkers of AKI, including transcriptomics, proteomics, gene arrays, lipidomics and imaging technologies. Clinical trials are underway to establish the validity of the biomarkers discovered using these techniques. This Review summarizes the importance of biomarkers of AKI, from their discovery to clinical practice, from the current perspective and that of what to expect in the future. Great strides forward are being made in breaking down important barriers to the successful prevention and treatment of this devastating disorder.

Key Points

  • A biomarker is a measurable indication of a specific biologic state that is relevant to a specific disease process

  • A perfect biomarker is easily measurable, accurate, reproducible, cost-effective, easy to interpret and provides useful clinical information

  • A biomarker of acute kidney injury (AKI) should independently provide information that is additive to that provided by conventional clinical factors and/or the biomarker should account for a large proportion of the risk associated with AKI

  • Biomarkers would be most useful in AKI for identification of at-risk individuals, surveillance of events that precede the condition, diagnosis and prognosis

  • Numerous potential biomarkers of AKI identified in preclinical investigations are now beginning to be tested in clinical validation studies

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Figure 1: Chronology of biomarker development.
Figure 2: Association between clinical stages of acute kidney injury and phases of biomarker utility.

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Acknowledgements

The authors acknowledge that portions of this manuscript were derived from a meeting held by the Acute Kidney Injury Network in Vancouver, BC, Canada, 11–14 September 2006. This work was supported by NIH grants DK56223, DK62324 and DK58413 to MDO, and by DK53465 and DK61594, and VA Merit Review, to BAM. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. BA Molitoris is Professor of Medicine and Director of the Division of Nephrology and VY Melnikov is a Fellow in the Division of Nephrology, in the Department of Medicine and the Indiana Center for Biologic Microscopy, Indiana University School of Medicine, Indianapolis, IN,

    Bruce A Molitoris & Vyacheslav Y Melnikov

  2. MD Okusa is John C Buchanan Distinguished Professor of Medicine in the Division of Nephrology, in the Department of Medicine, and Director of the Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, VA,

    Mark D Okusa

  3. J Himmelfarb is Director of the Division of Nephrology in the Department of Medicine, Center for Clinical and Translational Research, Maine Medical Center, Portland, ME, USA.,

    Jonathan Himmelfarb

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  1. Bruce A Molitoris
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Correspondence to Bruce A Molitoris.

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Molitoris, B., Melnikov, V., Okusa, M. et al. Technology Insight: biomarker development in acute kidney injury—what can we anticipate?. Nat Rev Nephrol 4, 154–165 (2008). https://doi.org/10.1038/ncpneph0723

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