Physiological biomarkers of acute kidney injury: A conceptual approach to improving outcomes

Mark D. Okusa, Bertrand L. Jaber, Peter Doran, Jacques Duranteau, Li Yang, Patrick T. Murray, Ravindra L Mehta, Can Ince

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Researchpeer-review

43 Citations (Scopus)


The past 5-10 years have brought significant advances in the identification and validation of novel biochemical biomarkers in the prevention and treatment of acute kidney injury (AKI). These biochemical biomarkers remain research tools but we anticipate that soon they will be employed in clinical practice. A Consensus Conference held by the Acute Dialysis Quality Initiative (ADQI) recently reviewed the evidence, and identified gaps and a research agenda. Furthermore, at this meeting was the birth of an initiative to comprehensively identify new opportunities to characterize the physiological changes during the course of AKI based upon a conceptual framework for the detection and monitoring of renal ischemia-reperfusion injury. This framework includes a transition from monitoring physiological biomarkers of adequate renal perfusion, to pathophysiologic biomarkers of renal hypoperfusion, and finally biomarkers of kidney cell structural injury/damage. Techniques to measure physiological changes in AKI include several physiological variables that might be used in an interactive way to supplement clinical information and biochemical damage biomarkers in the diagnosis and management of AKI. This review summarizes the spectrum of physiological parameters and potential new physiological methods that enable identification of high-risk patients for AKI, facilitate early diagnosis, and differential diagnosis to guide therapeutic management and prognostication. Finally, we propose a research agenda for the next 5 years to facilitate the development and validation of physiological biomarkers in AKI.

Original languageEnglish
Title of host publicationADQI Consensus on AKI Biomarkers and Cardiorenal Syndromes
PublisherS Karger AG
Number of pages17
ISBN (Print)9783318024067
Publication statusPublished - 2013
Externally publishedYes

Publication series

NameContributions to Nephrology
ISSN (Print)03025144

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