|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 71
Nephrocheck: A Big Step Forward in the Management of Acute Kidney Injury
Vishal Sehgal1, Sukhminder Jit Singh Bajwa2, Anurag Bajaj3
1 Department of Internal Medicine, University of South Carolina, Greenville, South Carolina, USA
2 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, India
3 Department of Emergency Medicine, Regional Hospital of Scranton, PA, USA
|Date of Web Publication||24-Apr-2015|
Sukhminder Jit Singh Bajwa
House No. 27-A, Ratan Nagar, Tripuri, Patiala - 147 001, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sehgal V, Bajwa SJ, Bajaj A. Nephrocheck: A Big Step Forward in the Management of Acute Kidney Injury. J Integr Nephrol Androl 2015;2:71
Acute kidney injury (AKI) is a common clinical entity in critical care and perioperative settings. , Most of the current diagnostic modalities are based on serum creatinine. However, it is an imperfect tool for diagnosis of AKI in the elderly population who has poor muscle mass. Often the diagnosis is too late, and irreparable damage is already done. As such a continual need is felt to devise and search newer diagnostic modalities for early diagnostic and therapeutic intervention. The emphasis is primarily on minimizing the morbidity and mortality associated with AKI by early diagnosis and management.
In recently published articles, the need for newer biomarkers for early diagnosis and management of AKI has been emphasized. , Food and Drug Administration has recently approved Nephrocheck as a diagnostic tool for early diagnosis of AKI. It is based on bioassay of two biomarkers. One of the marker being tissue inhibitor of metalloproteinases-2 (TIMP), and the other one is insulin-like growth factor binding protein 7 (IGFBP-7). Both are related to G1 cell cycle arrest during mitosis in cell replication. Bihorac et al. in a recent trial validated both these biomarkers as a diagnostic tool for AKI.  In a prospective multicenter study 420 patients were studied with the objective to analyze these two biomarkers for diagnosis of AKI within 12 h. The cut-off value was set at 0.3 for AKI. Immunoassay was used to measure urinary TIMP-2 and IGFBP-7. Both the biomarkers were strong predictors of AKI.
This is a big step forward in the management of AKI, which is associated high morbidity and mortality. , More data are likely to be available in coming years as the tests get incorporated into clinical practice. This should help in improving outcomes and reducing the cost to the health budget and society.
| References|| |
Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, et al
. Cost and Mortality Associated With Postoperative Acute Kidney Injury. Ann Surg May 2014;(doi:10.1097/SLA.0000000000000732 Epub ahead of print).
White LE, Hassoun HT, Bihorac A, Moore LJ, Sailors RM, McKinley BA, et al.
Acute kidney injury is surprisingly common and a powerful predictor of mortality in surgical sepsis. J Trauma Acute Care Surg 2013;75:432-8.
Bajwa SJ, Sharma V. Peri-operative renal protection: The strategies revisited. Indian J Urol 2012;28:248-55.
Sehgal V, Bajwa SJ, Sehgal R, Eagan J, Reddy P, Lesko SM. Predictors of acute kidney injury in geriatric patients undergoing total knee replacement surgery. Int J Endocrinol Metab 2014;12:e16713.
Bihorac A, Chawla LS, Shaw AD, Al-Khafaji A, Davison DL, Demuth GE, et al.
Validation of cell-cycle arrest biomarkers for acute kidney injury using clinical adjudication. Am J Respir Crit Care Med 2014;189:932-9.
Bihorac A, Yavas S, Subbiah S, Hobson CE, Schold JD, Gabrielli A, et al.
Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg 2009;249:851-8.
Hobson CE, Yavas S, Segal MS, Schold JD, Tribble CG, Layon AJ, et al.
Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 2009;119:2444-53.