• Thomas L Nickolas, Kai M Schmidt-Ott, Pietro Canetta, Catherine Forster, Eugenia Singer, Meghan Sise, Antje Elger, Omar Maarouf, David Antonio Sola-Del Valle, Matthew O'Rourke, Evan Sherman, Peter Lee, Abdallah Geara, Philip Imus, Achuta Guddati, Allison Polland, Wasiq Rahman, Saban Elitok, Nasir Malik, James Giglio, Suzanne El-Sayegh, Prasad Devarajan, Sudarshan Hebbar, Subodh J Saggi, Barry Hahn, Ralph Kettritz, Friedrich C Luft, and Jonathan Barasch.
• Columbia University College of Physicians and Surgeons, New York, NY, USA.
• J. Am. Coll. Cardiol. 2012 Jan 17;59(3):246-55.

ObjectivesThis study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department.BackgroundIntrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI.MethodsIn a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization.ResultsAll biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events.ConclusionsUrinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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