Clinical–Laboratory Medicine: An Alliance for the Optimal Management of Acute Kidney Injury with the Use of Biomarkers

Clinical medicine is practiced in the now. When faced with a patient, we may formulate a treatment plan based on both medical and clinical history; however, therapy is always prescribed prospectively, not retrospectively. This is no more a relevant challenge than when faced with a patient at risk of, or with, acute kidney injury (AKI). This syndrome reflects a broad spectrum of clinical presentations ranging from relatively mild to severe that may result in dysfunction with full recovery, dysfunction with partial recovery, or nonrecovery resulting in severe or permanent loss of renal function that is associated with substantial morbidity, mortality, and costs (1, 2). Despite all the well-documented data supporting this, AKI remains a disorder that is usually underrecognized or recognized late after the damaging event due, in part, to our commonly available diagnostic tools. The first assays for the measurement of creatinine in serum and plasma were published over a century ago, and although the Jaffe reaction using alkaline picrate remains the cornerstone of most currently available routine methods this approach is poorly suited for the acute management of AKI (3). Serum creatinine (SCr) concentration and urine output are functional markers …