Urinary Biomarkers for the Risk Assessment and Management of Heart Failure: Pearls and Pitfalls

We review potential applications and pitfalls of urinary biomarkers in people with heart failure (HF).

Albuminuria may indicate kidney damage and guide prioritization of medications in HF. Urine sodium is useful in guiding diuretic management. Several experimental urine biomarkers have been evaluated, with the most robust data available for neutrophil gelatinase-associated lipocalin, kidney injury marker 1, insulin-like growth factor-binding protein 7 in conjunction with tissue inhibitor of metalloproteinases-2, angiotensinogen, and N-acetyl-β-D-glucosaminidase. None provide diagnostic superiority over serum creatinine in evaluating risk of kidney injury. Some may have utility in identifying those at risk for adverse clinical outcomes. While urine albumin and sodium have prognostic and diagnostic utility in HF, the current role for other urine biomarkers is less clear, particularly in predicting worsening kidney function. Some of these biomarkers may provide mechanistic insights into kidney damage in HF.