Biomarkers for Acute Kidney Injury

Biomarkers play a crucial role in the diagnosis, stratification, monitoring, and prognosis of various diseases, including acute kidney injury (AKI). In this review, we explore the evolving landscape of biomarkers in AKI diagnosis and management. Traditionally, serum creatinine (SCr) and urinary output (UO) have served as standard biomarkers for AKI diagnosis and staging, yet they possess limitations in sensitivity and specificity, particularly in detecting subclinical AKI. The emergence of novel biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP7), offers promising avenues for the early detection and characterization of AKI. These biomarkers provide insights into tubular stress and kidney damage, even preceding the decline in glomerular function, thereby enabling timely intervention during the “golden hour of AKI prevention.” Furthermore, the integration of biomarker-guided approaches into clinical practice has shown significant potential in preventing AKI incidence and severity, particularly in high-risk patient populations, such as those undergoing surgery. Biomarker panels, comprising multiple markers tailored to different clinical indications, hold promise for refining AKI diagnosis and prognosis. This chapter highlights the transformative impact of biomarkers on AKI diagnosis and management, paving the way for precision medicine approaches and improved patient outcomes.