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NephroCheck data compared to serum creatinine in various clinical settings
Sahra Pajenda1, Aysegül Ilhan-Mutlu2, Matthias Preusser3
1Division of Nephrology and Dialysis, Department of Internal Medicine III, Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria. sahra.pajenda@meduniwien.ac.at.
Background:
Acute kidney injury is frequently observed at the intensive care unit, after surgery, and after toxic drug administration. A rise in serum creatinine and a fall in urine output are consequences of much earlier injury to the most sensitive part of tubular cells located at the proximal tubule. The aim of the present study was to investigate the course of two cell-cycle arrest urinary biomarkers compared to serum creatinine in four clinical settings: ischemic reperfusion injury, cardiac failure, severe acute kidney injury, and chemotherapy-induced kidney injury.
Methods:
A recently developed bedside test known as NephroCheck measures two urinary parameters: insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2). The test is based on a sandwich immunoassay technique. The final test output, labeled AKIRisk, is shown as a numeric result.
Results:
This report revealed that [IGFBP7] · [TIMP-2] in urine rise rapidly prior to any change in serum creatinine. A unique feature of all four clinical settings is that a rapid decline predicts the recovery of kidney function. Besides, a subclinical kidney injury might be detected by the test.
Conclusion:
This bedside test detects biomarkers of renal injury. A rapid decline in AKIRisk was associated with the restoration of kidney function, whereas a prolonged high AKIRisk score was associated with end-stage renal disease. However, the dynamics seem to differ, depending on the cause and the extent of injury. Further studies will be needed to clarify the issue.
Insights
A new bedside test detects kidney injury early by measuring urinary biomarkers insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2). A rapid decline in AKIRisk predicts kidney function recovery.
Area of Science:
- Nephrology
- Biomarker Discovery
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a common complication in intensive care units, post-surgery, and following toxic drug exposure.
- Rising serum creatinine and falling urine output indicate tubular cell injury, often occurring after the damage has begun.
- This study investigated two cell-cycle arrest urinary biomarkers against serum creatinine in four distinct clinical settings.
Observation:
- The NephroCheck assay measures urinary insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2).
- The AKIRisk score, derived from these biomarkers, is determined via a sandwich immunoassay.
- These urinary biomarkers increase before observable changes in serum creatinine levels.
Findings:
- The combined urinary biomarkers [IGFBP7]·[TIMP-2] rise rapidly, preceding alterations in serum creatinine.
- A swift decrease in the AKIRisk score is a strong predictor of kidney function recovery across all studied clinical scenarios.
- The test demonstrated potential in detecting subclinical kidney injury.
Implications:
- The bedside AKIRisk test offers early detection of renal injury.
- A declining AKIRisk score correlates with restored kidney function, while persistently high scores suggest progression to end-stage renal disease.
- Further research is necessary to fully elucidate the differing biomarker dynamics based on injury etiology and severity.
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