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David Plaut: Off the Cuff

Kidney Diagnostic Markers

Published April 22, 2014 4:46 PM by David Plaut

Unlike the progressive development of biomarkers in cardiology, there have been few changes in kidney diagnostic markers. Creatinine is still used as an indicator of kidney function, but not of the parenchymal kidney injury. Serum creatinine concentration does not change until around 50% of kidney function is lost, and varies with muscle mass, age, sex, medications and hydration status. The lag time between injury and loss of function and the risks missing a therapeutic opportunity may explain the high associated mortality.

It is clear that patient NGAL level is an appropriate, sensitive and specific -- early biomarker of AKI caused by a variety of different etiologies. It is advised that a multidisciplinary group of experts come together to make recommendations and propose a consensus of clinical procedures to advance the most efficacious NGAL monitoring protocol for early detection and treatment of patients with AKI.1 It is important to note that NGAL, in the absence of diagnostic increases in serum creatinine, is able to detect some patients affected by subclinical AKI who have an increased risk of adverse outcome.2

Another marker that has been found useful is cystatin c. For example, Cha et al. found chronic kidney disease stages were more sensitively differentiated by cystatin C compared to sCr, especially in moderate and severe kidney dysfunction. Sex and body mass index did not affect cystatin C level.3

1.   Postgrad Med. 2013 Nov;125(6):82-93. Peacock WF et al.

2.   Clin Chem Lab Med. 2012 Feb 15;50(9):1505-17,Clerico A

3.   Nephrology (Carlton). 2010 Dec;15(8):768-76. Cha RH

posted by David Plaut

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