Can biomarkers assist in the diagnosis of AKI HRS
Biomarkers of kidney tubular injury may help with the differential diagnosis of AKI (prerenal azotemia ATN or AKI-HRS).
Multiple biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver type fatty acid binding protein (l-FABP), and kidney injury molecule-1 (KIM-1), have been shown to distinguish structural from functional causes of AKI in numerous clinical settings.
NGAL performs well in the cirrhotic population, especially in distinguishing between prerenal azotemia, non-HRS cases of AKI, AKI-HRS, and ATN with an area under the receiver operating characteristic curve of 0.957.
A study suggests that combining a panel of these biomarkers is the most accurate way to separate structural from functional causes of AKI.
These biomarkers are still not readily commercially available worldwide. The commercially available biomarker strip, Nephrocheck, has never been tested in cirrhosis, and therefore cannot be recommended.
In the future, clinicians should be able to diagnose ATN versus AKI-HRS early using biomarkers that differentiate these two conditions.
Biomarkers may also be used to track transition from one type of AKI, such as prerenal azotemia, as it evolves into AKI-HRS over time, or to follow the response of the kidneys to treatment.