Determining Acute Kidney Injury

Determining Acute Kidney Injury

McGowan Institute for Regenerative Medicine affiliated faculty member John Kellum, MD, a professor of critical care medicine at the University of Pittsburgh, a transplant physician in anesthesiology at the Thomas E. Starzl Transplantation Institute, and co-director at the Mechanisms and Novel Therapies for Resuscitation and Acute Illness (MANTRA) Lab, discussed the pathogenesis of acute kidney injury (AKI) as a member of an international panel of critical care experts at the event, “Early AKI Assessment: Are New Biomarkers Rising to the Challenge,” held in conjunction with the Society of Critical Care Medicine (SCCM) 43rd Critical Care Congress in San Francisco, California. The panel discussed how new biomarkers for risk assessment of AKI could affect the care of critically ill patients. Dr. Kellum was joined with experts from the Mayo Clinic, the University of Michigan Health System, and the University of Florida.

AKI is a complex and increasingly prevalent condition associated with high mortality and morbidity in critically ill patients. Failure to recognize and manage AKI in the early stages can lead to devastating outcomes for patients and increased costs to the healthcare system. Because AKI develops quickly (over the course of hours) and current tools available to physicians for risk assessment are inadequate, the condition often goes undetected until it is too late to help the patient.

AKI risk is difficult to determine because the condition is typically caused by something outside of the kidney, including sepsis, nephrotoxins, and oxygen deprivation. An international, multi-center study led by UPMC researchers aimed to identify early markers in order to detect AKI when interventions could provide benefit. Researchers collected blood and urine samples of more than 1,000 critically ill patients in North America and Europe. The biomarkers, known as TIMP-2 and IGFB7, signal that the kidneys are stressed and not functioning properly but may still recover. They are indicators of cell damage, a key component in the onset of AKI.

“These biomarkers send an early ‘alarm’ from the site of the injury and offer a better chance at treatment that can prevent further damage,” Dr. Kellum said.