NEW YORK— Researchers have discovered a new way to diagnose Acute Kidney Injury (AKI) using a urine test enabling emergency departments to identify high-risk patients upon arrival, according to a study published online January 8 in the Journal of the American College of Cardiology.
Physicians measure a patient's creatinine levels to determine kidney function, but levels can remain normal for several hours after acute kidney damage. An accurate assessment requires measurements taken over a period of one to three days. However, urinary biomarkers require only half an hour to measure the severity of kidney damage, explains Thomas Nickolas, MD, MS, assistant professor of clinical medicine at Columbia University College of Physicians and Surgeons and kidney specialist at NewYork-Presbyterian Hospital/The Allen Hospital in a news release.
In an international study, researchers at NewYork-Presbyterian Hospital/Columbia University Medical Center, Staten Island University Hospital, and Charité-Universitätsmedizin, Max Delbruck Center for Molecular Medicine, and Helios Clinics, Berlin, Germany, took a single measure of five urinary biomarkers from 1,635 emergency room patients upon their admission to the hospital.
All five biomarkers were elevated in cases of iAKI (intrinsic AKI, the most severe form of AKI). The biomarker called uNGAL was most accurate in the diagnosis of iAKI, and best predicted its duration and severity. uNGAL, along with biomarker Kim-1, most effectively predicted the need for dialysis. uNGAL was discovered at NewYork-Presbyterian Hospital/Columbia University Medical Center and at Cincinnati Children’s Hospital. It was measured in this study by Abbott’s ARCHITECT-NGAL assay, which is available commercially outside the United States.
“The ability to identify acute kidney damage while the patient is in triage is especially important in busy urban hospitals, where patients cannot wait for repetitive measures of creatinine and are frequently lost to follow-up," said senior author Jonathan Barasch, MD, PhD, associate professor of medicine and of anatomy and cell biology at Columbia University College of Physicians and Surgeons and a kidney specialist at NewYork-Presbyterian Hospital/The Allen Hospital in a news release. “The use of urinary biomarkers could also be of great use to the military, at disaster sites, and in other situations where quick medical decisions must be made."
