Intended for healthcare professionals

Clinical Review State of the Art Review

Sepsis associated acute kidney injury

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k4891 (Published 09 January 2019) Cite this as: BMJ 2019;364:k4891

Re: Sepsis associated acute kidney injury

Current consensus definitions of acute kidney injury (AKI) are based on correlates of renal function, namely serum creatinine levels and measurement of urine output. Therefore by definition, on clinical diagnosis of AKI, the kidney is already functionally impaired by the original insult(s). Biomarkers of AKI offer a putative opportunity to identify the “at risk” kidney in the variable window of time between insult and functional impairment.

A biomarker that is highlighted in this review paper is NGAL (neutrophil gelatinase-associated lipocalin). Within hospitals in the United Kingdom, neither serum nor urinary NGAL are used clinically as a biomarker of early acute kidney injury. The most recent National Institute for Health and Care Excellence (NICE) guidelines for the detection of AKI still focus on the use of serum creatinine and urine output measures. Cost-effectiveness data suggests that the use of NGAL may be financially viable, with estimates of £24 per urinary NGAL test, although a lack of clinical studies mean that it is not clear whether routine urinary NGAL measurements provide any clinical benefit over current AKI diagnostic methods (1). Urinary NGAL has however proven to be useful in experimental ex vivo normothermic perfusion studies of declined kidneys in the context of renal transplantation (2).

References:
1. NICE Medtech innovation briefing - The NGAL Test for early diagnosis of acute kidney injury (2014) [Online] https://www.nice.org.uk/advice/mib3/resources/the-ngal-test-for-early-di... [Accessed February 2019]
2. Hosgood SA, Nicholson ML. An assessment of Urinary Biomarkers in a Series of Declined Human Kidneys Measured During Ex Vivo Normothermic Kidney Perfusion. Transplantation. 2017 Sep; 101(9): 2120-2125.

Competing interests: No competing interests

16 February 2019
Stephanie F Smith
Core Surgical Trainee
West Suffolk Hospital
Hardwick Lane, Bury Saint Edmunds, IP33 2QZ