Biomarkers of AKI in clinical practice

Is there any progress in the use of biomarkers of acute kidney injury (AKI) in clinical practice? Are we close to “kidney troponins”?

Jürgen Floege, MD: We have some very good biomarkers now and I will refrain from mentioning any of them; there are several of them. The problem that I have with them is how to use them in clinical practice. I often have people sitting in my office and telling me, “You need to introduce this into your clinical practice.” I ask them why, and that is when they get nervous. I can detect AKI earlier, but what do I do differently then? “You could hydrate your patient”—I do that anyway.

I think the best biomarker is a good intensivist who will recognize that this patient has a problem and may involve a nephrologist. That is the best biomarker.

The moment we would ever have real therapy for AKI, then we will need a biomarker. Then I would want to know 6, 10, 12 hours earlier whether my patient does develop AKI. But right now, if the whole consequence is keeping the blood pressure up and keeping the patient hydrated, I do not think I need a laboratory biomarker or a renal troponin.