Dynamic Biomarker Assessment: A Diagnostic Paradigm to Match the AKI Syndrome
Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of...
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| Published in: | Frontiers in pediatrics Vol. 7; p. 535 |
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| Language: | English |
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21.01.2020
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| Abstract | Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of injury as well as to reconsider the existing diagnostic framework. Novel urinary and serum biomarkers of injury have, however, not been readily integrated into practice-partially because of the limited scope to current testing. The predominant focus to date has been the adjudication of a single biomarker measured at a single point of time for the prediction of either AKI progression or disease-related mortality. This approach is pragmatically problematic. The imprecise, umbrella classification of AKI diagnosis coupled with the absence of a consistently effective set of therapies creates a difficult rubric for biomarkers to demonstrate value in the scope of practice. AKI is, however, not a binary process but more an ICU syndrome-with complex biology underpinning injury, interacting and disrupting other organ function, multidimensional in manifestation, and varying in severity over time. As such, a more appropriate diagnostic paradigm is needed. In this minireview, the status quo for AKI diagnosis and associated limitations will be discussed, and a novel, dynamic, and multidimensional paradigm will be presented. Appreciation of AKI as an ICU syndrome and creation of an appropriately matching and sophisticated diagnostic platform of injury assessment are possible and represent the next step in AKI management. |
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| AbstractList | Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of injury as well as to reconsider the existing diagnostic framework. Novel urinary and serum biomarkers of injury have, however, not been readily integrated into practice-partially because of the limited scope to current testing. The predominant focus to date has been the adjudication of a single biomarker measured at a single point of time for the prediction of either AKI progression or disease-related mortality. This approach is pragmatically problematic. The imprecise, umbrella classification of AKI diagnosis coupled with the absence of a consistently effective set of therapies creates a difficult rubric for biomarkers to demonstrate value in the scope of practice. AKI is, however, not a binary process but more an ICU syndrome-with complex biology underpinning injury, interacting and disrupting other organ function, multidimensional in manifestation, and varying in severity over time. As such, a more appropriate diagnostic paradigm is needed. In this minireview, the status quo for AKI diagnosis and associated limitations will be discussed, and a novel, dynamic, and multidimensional paradigm will be presented. Appreciation of AKI as an ICU syndrome and creation of an appropriately matching and sophisticated diagnostic platform of injury assessment are possible and represent the next step in AKI management.Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of injury as well as to reconsider the existing diagnostic framework. Novel urinary and serum biomarkers of injury have, however, not been readily integrated into practice-partially because of the limited scope to current testing. The predominant focus to date has been the adjudication of a single biomarker measured at a single point of time for the prediction of either AKI progression or disease-related mortality. This approach is pragmatically problematic. The imprecise, umbrella classification of AKI diagnosis coupled with the absence of a consistently effective set of therapies creates a difficult rubric for biomarkers to demonstrate value in the scope of practice. AKI is, however, not a binary process but more an ICU syndrome-with complex biology underpinning injury, interacting and disrupting other organ function, multidimensional in manifestation, and varying in severity over time. As such, a more appropriate diagnostic paradigm is needed. In this minireview, the status quo for AKI diagnosis and associated limitations will be discussed, and a novel, dynamic, and multidimensional paradigm will be presented. Appreciation of AKI as an ICU syndrome and creation of an appropriately matching and sophisticated diagnostic platform of injury assessment are possible and represent the next step in AKI management. Acute kidney injury (AKI) affects one in four neonates, children, and adults admitted to the intensive care unit (ICU). AKI-associated outcomes, including mortality, are significantly worsened. Several decades of research demonstrate evidence for a need to rethink the pathophysiology and drivers of injury as well as to reconsider the existing diagnostic framework. Novel urinary and serum biomarkers of injury have, however, not been readily integrated into practice—partially because of the limited scope to current testing. The predominant focus to date has been the adjudication of a single biomarker measured at a single point of time for the prediction of either AKI progression or disease-related mortality. This approach is pragmatically problematic. The imprecise, umbrella classification of AKI diagnosis coupled with the absence of a consistently effective set of therapies creates a difficult rubric for biomarkers to demonstrate value in the scope of practice. AKI is, however, not a binary process but more an ICU syndrome—with complex biology underpinning injury, interacting and disrupting other organ function, multidimensional in manifestation, and varying in severity over time. As such, a more appropriate diagnostic paradigm is needed. In this minireview, the status quo for AKI diagnosis and associated limitations will be discussed, and a novel, dynamic, and multidimensional paradigm will be presented. Appreciation of AKI as an ICU syndrome and creation of an appropriately matching and sophisticated diagnostic platform of injury assessment are possible and represent the next step in AKI management. |
| Author | Basu, Rajit K. |
| AuthorAffiliation | Division of Critical Care, Department of Pediatrics, Emory School of Medicine, Children's Healthcare of Atlanta , Atlanta, GA , United States |
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| CitedBy_id | crossref_primary_10_1016_j_ccc_2020_11_007 crossref_primary_10_34067_KID_0006892020 crossref_primary_10_1007_s00467_021_05368_2 crossref_primary_10_34067_KID_0003552020 crossref_primary_10_1038_s41390_020_01140_8 crossref_primary_10_1016_j_siny_2021_101261 crossref_primary_10_1186_s13052_025_01899_8 crossref_primary_10_1016_j_semnephrol_2023_151439 crossref_primary_10_1111_pedi_13370 crossref_primary_10_2215_CJN_11000821 crossref_primary_10_3390_jcm9041104 crossref_primary_10_1055_s_0041_1732447 crossref_primary_10_1016_j_rvsc_2020_11_005 crossref_primary_10_1007_s40620_022_01534_3 |
| Cites_doi | 10.1159/000349964 10.2215/CJN.01300216 10.1159/000437237 10.1681/ASN.2014070724 10.1177/2054358117692560 10.1016/j.jtcvs.2016.01.037 10.1053/j.ackd.2016.03.001 10.1016/j.kint.2016.02.027 10.1159/000349963 10.1097/CCM.0b013e3182a639da 10.1186/cc9004 10.1016/j.mbs.2018.05.010 10.1053/j.ackd.2017.10.013 10.1080/1354750X.2017.1387934 10.1097/MNH.0000000000000292 10.1038/s41581-018-0052-0 10.1681/ASN.2015030233 10.1159/000349962 10.1542/peds.2014-2949 10.1016/j.ekir.2016.04.005 10.1681/ASN.2016101127 10.2215/CJN.12191213 10.1016/j.jcrc.2019.05.017 10.1093/ndt/gfs380 10.1097/CCM.0000000000003738 10.2215/CJN.00710113 10.1097/CCM.0000000000002847 10.1016/S2352-4642(17)30069-X 10.1186/cc11240 10.1097/CCM.0b013e31821201d3 10.1681/ASN.2013070758 10.1038/ki.2013.349 10.1038/nrneph.2013.282 10.1016/j.jacc.2014.09.066 10.1038/nrneph.2017.2 10.1038/nrneph.2017.9 10.1681/ASN.2012070653 10.2215/CJN.07201009 10.1016/j.ekir.2017.05.012 10.1097/PCC.0000000000001866 10.1038/nrneph.2012.197 10.1186/s12882-017-0629-z 10.1056/NEJMoa1611391 10.1681/ASN.2017010055 10.1001/jamapediatrics.2017.4540 |
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| Keywords | NGAL TIMP2/IGFBP7 syndrome FST biomarkers pediatrics critical care AKI |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 Edited by: David Joseph Askenazi, University of Alabama at Birmingham, United States This article was submitted to Pediatric Nephrology, a section of the journal Frontiers in Pediatrics Reviewed by: Andrew Mallett, Royal Brisbane and Women's Hospital, Australia; Aftab S. Chishti, University of Kentucky, United States |
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| Title | Dynamic Biomarker Assessment: A Diagnostic Paradigm to Match the AKI Syndrome |
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