Clinical Use of the Urine Biomarker [TIMP-2] × [IGFBP7] for Acute Kidney Injury Risk Assessment

• DOI: 10.1053/j.ajkd.2015.12.033
• Publication Date: 2016-03-05T10:37:07Z
• Authors: Anitha Vijayan; Sarah Faubel; David J. Askenazi; Jorge Cerda; William H. Fissell; Michael Heung; Benjamin D. Humph...; Jay L. Koyner; Kathleen D. Liu; Girish Mour; Thomas D. Nolin; Azra Bihorac; Sarah Faubel; David J. Askenazi; Rajit K. Basu; Udayan Y. Bhatt; Azra Bihorac; Jorge Cerda; Michael J. Connor; Alan J. Davidson; Mark P. de Caeste...; Kent Doi; William H. Fissell; Ladan Golestaneh; Michael Heung; Benjamin D. Humph...; Jay L. Koyner; Kathleen D. Liu; Girish K. Mour; Prabhleen Singh; Charuhas V. Thakar; Anitha Vijayan
• Keywords: Clinical Trials as Topic; Tissue Inhibitor of Metalloproteinase-2; Biomarkers/urine; Acute Kidney Injury/diagnosis; Decision Trees; Acute Kidney Injury; Risk Assessment; 6. Clean water; 3. Good health; Insulin-Like Growth Factor Binding Proteins; 03 medical and health sciences; Early Diagnosis; 0302 clinical medicine; Tissue Inhibitor of Metalloproteinase-2/urine; Humans; Insulin-Like Growth Factor Binding Proteins/urine; Risk Assessment/methods; Biomarkers

Acute kidney injury (AKI) is a serious complication, commonly occurring in the critically ill population, with devastating short- and long-term consequences. Despite standardization of the definition and staging of AKI, early recognition remains challenging given that serum creatinine level is a marker, albeit imperfect, of kidney function and not kidney injury. Furthermore, the delay in increase in serum creatinine level after loss of glomerular filtration also prevents timely detection of decreased kidney function in patients with AKI. During the past decade, numerous clinical investigations have evaluated the utility of several biomarkers in the early diagnosis and risk stratification of AKI. In 2014, the US Food and Drug Administration approved the marketing of a test based on the combination of urine concentrations of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 ([TIMP-2] × [IGFBP7]) to determine whether certain critically ill patients are at risk for developing moderate to severe AKI. The optimal role of this biomarker in the diagnosis, management, and prognosis of AKI in different clinical settings requires further clarification. In this perspective, we summarize the biological actions of these 2 cell-cycle arrest biomarkers and present important considerations regarding the clinical application, interpretation, and limitations of this novel test for the early detection of AKI.