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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2015; 4(2): 160-168
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.160
Novel biomarkers of acute kidney injury: Evaluation and evidence in urologic surgery
Marianne Schmid, Deepansh Dalela, Rana Tahbaz, Jessica Langetepe, Marco Randazzo, Roland Dahlem, Margit Fisch, Quoc-Dien Trinh, Felix K-H Chun
Marianne Schmid, Deepansh Dalela, Quoc-Dien Trinh, Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Marianne Schmid, Rana Tahbaz, Jessica Langetepe, Roland Dahlem, Margit Fisch, Felix K-H Chun, Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
Deepansh Dalela, Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, United States
Marco Randazzo, Department of Urology, Cantonal Hospital Aarau, 5000 Aarau, Switzerland
Author contributions: All authors of this paper have substantially participated in the planning, execution, and data interpretation of the study; in addition, they have written, read and approved the final version submitted; all the authors contributed to the study concept, design, acquisition, interpretation, drafting, critically revision for important intellectual content of the manuscript.
Conflict-of-interest: The authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Felix K-H Chun, MD, Associate Professor of Urology, Department of Urology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. chun@uke.de
Telephone: +49-40-741053486
Received: July 16, 2014
Peer-review started: July 17, 2014
First decision: August 14, 2014
Revised: December 30, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: May 6, 2015
Abstract

Patients undergoing urologic surgery are at risk of acute kidney injury (AKI) and consequently long-term deterioration in renal function. AKI is further associated with significantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identification of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine (SCr), which is known to be an inaccurate marker of early changes in renal function. Therefore, several new urinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.

Keywords: Acute kidney injury, Urology, Outcome, Renal function, Biomarker, Surgery

Core tip: Patients undergoing renal surgery represent a unique population at risk of acute kidney injury (AKI). AKI is known to be associated with adverse perioperative outcomes. Therefore, efforts are warranted to promote awareness for AKI. Novel biomarkers promise to improve early and accurate detection of AKI, which may help to provide better patients’ outcomes. However, these biomarkers still have to prove their clinical effectiveness prior to their implementation into urologic surgery settings.