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Biomarker (sources) | Origin in AKI cases | Physiological function | Significance of rise | Studied clinical settings | Assay platform |
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NGAL (urine and circulating) | Urine: local synthesis in distal nephron in response to injury and secreted into urine Circulating: synthesized systemically in response to renal injury, filtered by glomerulus, and uptaken by proximal tubular cells with a little amount secreted in the urine | Bacteriostatic action, antioxidant effect, and growth and differentiation factor | Tubular injury (ischemia and nephrotoxins) | (i) Early detection of AKI after cardiac surgery in heterogeneous ICU population, in the emergency department, and after administration of nephrotoxins (ii) Risk stratification (iii) Prognostic marker after kidney transplantation (iv) Monitoring interventional trials in AKI (v) Prognosis of dialysis requirement in case of AKI establishment (vi) Prognosis of mortality | WB-ELISA-PETIA-POCT-CMIA |
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Cystatin C (urine and circulating) | Produced at a constant rate by nucleated cells, filtered by glomerulus, and almost completely reabsorbed in the proximal tubules | Inhibitor of lysosomal proteases and extracellular inhibitor of cysteine proteases | Change in GFR (proximal tubule injury) | (i) Early detection of AKI after cardiac surgery in heterogeneous ICU population and after administration of nephrotoxins (ii) Prognosis of mortality | PENIA-PETIA-ELISA |
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KIM-1 (urine) | Type 1 transmembrane protein that is highly expressed in dedifferentiated proximal tubule epithelial cells after ischemic or toxic injury and is not detectable in normal tissue | Regeneration process after epithelial injury, scavenger receptor for the removal of dead cells from tubular lumen through phagocytosis | Tubular injury (ischemia and nephrotoxins) | (i) Early detection of AKI after cardiac surgery and after administration of nephrotoxins (ii) Prognosis of dialysis requirement in case of AKI establishment (iii) Prognosis of mortality | WB-ELISA |
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IL-18 (urine) | Proinflammatory cytokineoriginates from tubular epithelial cells | Inflammation and immunomodulation mediator | Tubular injury (ischemia and nephrotoxins) | (i) Early detection of AKI after cardiac surgery in heterogeneous ICU population (ii) Prognostic marker after kidney transplantation (iii) Prognosis of mortality | ELISA |
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L-FABP (urine and circulating) | Production in the liver determines blood levels. Renal L-FABP is found in cytoplasm of the proximal tubules | Renal L-FABP helps maintain low levels of free fat acids in the cytoplasm | Tubular injury (ischemia and nephrotoxins) | (i) Early detection of AKI after cardiac surgery (ii) Prognosis of mortality | ELISA |
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