ABSTRACTS from 16th International COnference on ... - CRRT Online

Differential Diagnosis of AKI: Can Biomarkers Help?
Zoltan Endre MD, PhD
2:30-2:45
Thursday, February 16
Educational Objectives:
1. Outline the ADQI Conclusions regarding the use of Specific and Contextual Biomarkers in the Differential
Diagnosis of AKI
2. Highlight that pre-renal AKI is not purely a functional injury
3. Outline Cause and Phase-Specificity of Structural Biomarkers
Content Description:
After re-defining AKI as a matrix of structural injury and functional change, there was consensus in proposing
the use of biomarkers in differentiating cause and type of renal injury. Increases in urinary or serum biomarkers
of cellular injury predict poor outcomes even in the apparent absence of renal functional change.
Recent evidence shows that injury biomarkers are increased in pre-renal AKI and that this condition is not a
unique functional injury without adverse consequences, but is rapidly reversible because it represents the milder
end of a continuum of renal injury. The term “pre-renal” should be confined to a cause of AKI.
Some biomarkers may be cause–specific and facilitate differential diagnosis of AKI. However, history and contextual
biomarkers such as ultrasound, urine microscopy and markers of systemic inflammation or sepsis, renal
histology, and the biomarkers of other concurrent or contributing disease processes are also important in differentiating
a specific causal pathway.
In addition to defining cause, we need to determine the phase of injury in order to link the pathophysiology of
early AKI to particular biomarker profiles. Phase-specific biomarkers that localize injury and define renal pathophysiology
in real time may be more critical in suggesting patient-specific treatment than the detection of injury
itself. Some phase-specific biomarkers are already available. We postulate that these and newer biomarkers will
allow a mechanistic differential diagnosis that will define and individualise future treatment.
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