What is the role of biomarkers in the workup of acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The most commonly used markers of kidney function—serum creatinine level, glomerular filtration rate (GFR), and urinary output—are limited in their ability to determine the magnitude of renal injury. This has led to research to find more accurate kidney function biomarkers (serum and/or urine), [21] in the hope that such biomarkers, once identified, will permit early diagnoses and will aid in rendering appropriate treatment strategies before permanent damage has occurred. Research has focused on the following potential biomarkers:

  • Neutrophil gelatinase-associated lipocalin (NGAL)
  • Interleukin-18 (IL-18)
  • Kidney injury molecule 1 (KIM-1)
  • Cystatin C
  • Sodium/hydrogen exchanger isoform 3 (NHE3)

In a multicenter, prospective cohort study of 102 patients with cirrhosis and acute kidney injury (AKI), Belcher and colleagues assessed multiple urinary biomarkers used to determine the three most common etiologies of AKI: ATN, prerenal azotemia, and hepatorenal syndrome (HRS). Median values of the following biomarkers were significantly higher in patient with ATN [22] :

  • NGAL
  • IL-18
  • KIM-1
  • Liver-type fatty acid binding protein (L-FABP)
  • Albumin

Further research is needed before novel renal biomarkers are incorporated into clinical practice.


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