News in brief

A large multicenter study carried out by clinicians of the Experimental and Clinical Research Center (Berlin, Germany), a joint cooperation between the Max Delbruck Center for Molecular Medicine (Berlin-Buch, Germany) and the Charite Universitatsmedizin (Berlin, Germany), the Helios Hospital (Berlin, Germany), and two hospitals in the USA, has demonstrated that two potential biomarkers, NGAL and KIM-1, may be useful in providing an early risk assessment for patients presenting with kidney disorders. The study found that high levels of NGAL and KIM-1 indicate an increased risk of acute kidney damage, which in turn increases the risk of patients dying in the hospital or requiring dialysis treatment. “In the initial stage of acute kidney injury, we may have most room for improvement of our current clinical practice,” suggests Kai Schmidt-Ott from the Experimental and Clinical Research Center. He recommends that clinicians should base their diagnoses on the NGAL and KIM-1 biomarker readings as well as the serum creatinine levels to give a more exact assessment of the individual patient’s risk. Jonathan Barasch, (Columbia University, NY, USA), the senior author of the paper, explained that, “When a patient presents to the emergency department and a blood test identifies an abnormal creatinine value, it is difficult to know whether the patient needs to be hospitalized because of ongoing intrinsic acute kidney injury (a potentially fatal disease) or whether the patient needs to be sent home after intravenous or oral fluids and later examined at an outpatient clinic.” At present, the serum creatinine level alone is used for the diagnosis of acute kidney injury. Owing to creatinine being a molecule that is normally excreted via the kidney, it accumulates in the blood when kidney function is impaired. However, high levels of serum creatinine are not immediately indicative of acute kidney injury; the level could have built up over a longer period of time, and therefore may not indicate tissue damage. Measuring serum creatinine levels alone is not particularly helpful to doctors in deciding how to proceed with treatment. Damaged kidneys synthesize several other specific proteins. This large-scale study involved taking a single measure of five of these proteins used as urinary biomarkers from almost 1635 emergency room patients at the time of hospital admission, in order to determine which could be used to evaluate patient risk. The findings are hoped to help tackle a real problem: in the USA alone, 1 million patients are diagnosed every year with severe acute kidney injury. Further research is needed to determine whether or not all patients admitted to an emergency room should be tested for the biomarkers. It also remains to been seen whether or not these biomarkers influence the individual treatment outcome.