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

D12
Biomarkers 2: Application in AKI
Zoltan Endre MD, PhD
8:15-9:45
Wednesday, February 15
Educational Objectives:
1. Describe the use of Specific and Contextual Biomarkers in the Differential Diagnosis of AKI
2. Outline Cause and Phase-Specificity of Structural Biomarkers
Content Description:
What really matters in AKI is developing the ability to individualise patient care. Increases in urinary or serum
biomarkers of cellular injury predict poor outcomes even in the apparent absence of renal functional change. It is
therefore postulated that early detection of AKI using injury biomarkers might lead to successful intervention in
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.
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.
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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