Early AKI Bio Significance

Early AKI Bio significance ●​ Detection of structural injury prior to dysfunctionality ●​ Able to identify patient in risk group ○​ Overall, higher chance of treatment success, since we will identify and focus our resource on ones who really need treatments ○​ Early preventive interventions ●​ Traditional approach ○​ AKI diagnose post creatinine increases ○​ Injury that has already been established ○​ Limitation on opportunity for prevention ●​ Biomarkers approach ○​ Injury in pink AKI window ■​ Early hemodynamic optimizations ■​ Avoidance of nephrotoxins ■​ Intensive monitoring ■​ ICU triage ●​ Only for high-risk patients Biomarkers vs Creatinine ●​ Subject of reflections ○​ Biomarkers on early injury will reflect structural tubular injury ○​ Creatinine GFR decline ●​ Time of rise ○​ Hours after insult ■​ Biomarkers ○​ 24-48hr ■​ Creatinine ●​ Sensitivity ○​ Tends to be higher on early injury for biomarkers ○​ Low and late marker for creatinine ●​ Specificity ○​ Moderate (biomarker) ○​ High (creatinine) ■​ Reduced GFR ●​ Prognostic value ○​ In early injury biomarkers are strong ○​ Limited for creatinine Creatinine will increase post-nephron loss Some patients have despite recovery ●​ Normalization of creatine ●​ Subclinical fibrosis ●​ Biomarker in stable or mildly elevated ○​ This will explain on delayed CKD developments ●​ Functional recovery does not mean its structural recovery ●​ Hidden injury phase ○​ Early AKI window ■​ Renal tubular cells will be… ●​ Stressed ●​ Dedifferentiating ●​ Cell-cycle arrest ■​ Non-measurable changes in creatinine ○​ Biomarkers such as NGAL,KIM-1, IL-18, TIMP-2/IGFBP-7 will detect structural injury and cellular stress ■​ Increase in hours ■​ Revealing AKI on functional decline ○​ Biomarkers will sense hidden injury ●​ Reactive traditional ○​ Insult occurs ○​ Creatinine increases ○​ AKI ○​ But damage already done Limited ability on reserving injury ●​ Preventive model ○​ Insult occurs ○​ Biomarker increases ○​ Early intervention in injury phase ○​ Reduced progression