Differential diagnosis of acute kidney injury

Abstract

Acute kidney injury (AKI) is a common entity in clinical practice. There are three main mechanisms of kidney injury depending on the location of causative factors, i.e. pre-renal, renal and post-renal. The differential diagnosis of acute kidney injury at an early stage is crucial since it allows a choice of the specific treatment methods directed towards the prognosis of the patient and renal survival. There are several traditional biomarkers of renal function currently used for the diagnosis of acute kidney injury, such as serum creatinine and urine output. A number of new candidate biomarkers that may help diagnose and determine the etiology of AKI have been recently studied. They include neutrophil-gelatinase associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (IL-18), liver-type fatty acid-binding protein (L-FABP), calprotectin, tissue inhibitor of metalloproteinases 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGDBP-7). The measurement of these potential biomarkers in serum or urine at baseline and the estimation of their changes later in the course of the disease may be useful for both the differential diagnosis of acute kidney injury and for the assessment of the prognosis of the patients and likelihood of the development of chronic kidney disease. The article reviews the role of new biomarkers of acute kidney injury.