METHOD FOR ESTIMATING PREOPERATIVE RISK OF ACUTE KIDNEY INJURY

Caritas St. Elizabeth's Medical Center
posted on 02/13/2009

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Description: Acute kidney injury is a serious complication of cardiac surgery. Currently available tools for the preoperative risk stratification of acute kidney injury are imprecise. In the past, several agents have been used as potential treatments of AKI to impact the high mortality associated with AKI, without much success. One reason for the failure of these therapeutic interventions in clinical trials of AKI is the dependency of serum creatinine as a screening process for initial enrollment of patients, for the diagnosis of AKI and for initiating the intervention. AKI has been typically diagnosed by a progressive rise in serum creatinine over several days, which may or may not be associated with oliguria, (decreased urine output for example producing less than 500 ml of urine in 24 hours).
Several markers have been explored for early diagnosis of AKI, including cytokines such as IL18. Although the initial studies on some molecules like tubular enzymes, growth factors, adhesion molecules and some cytokines (14 16, 29 31) were promising, subsequent studies have shown inadequate sensitivity or specificity to advocate clinical use for diagnosis. The invention in one embodiment is a method for identifying a subject having a risk of acute kidney injury by determining levels of at least two AKI associated markers in a subject, wherein a significant change in levels of the AKI associated markers relative to a standard level is indicative of a subject having a risk of acute kidney injury. This approach provides increased precision over existing methods.