engleski

Biomarkers of Acute Kidney Injury (AKI) in Cardiorenal Syndrome (CRS) - What Works and What Doesn’t

Introduction Cardiorenal syndrome, first described in 2004, has been a point of contention and controversy ever since its first mention and definition, as the spectrum of disease entities connecting the heart and the kidney is hard to adequately classify and define. One of the greatest controversies related to cardiorenal syndrome is properly defining the criteria for acute kidney injury (AKI) in the context of heart failure, since several studies have demonstrated that transient changes in the serum creatinine concentration during the process of heart failure treatment may not accurately represent the true extent of renal injury. This narrative review aims to evaluate and describe the diagnostic qualities and features of creatinine, cystatin C and neutrophil gelatinase- associated lipocalin (NGAL) for making the diagnosis of AKI in patients with heart failure. Materials and methods A search of the literature was performed using the MEDLINE, Scopus, Web of Science and Google Scholar databases. Papers were excluded if they described the use of creatinine, cystatin C or NGAL in contexts other than diagnosing AKI in patients with heart failure. Results The analyzed literature shows that the serum creatinine concentration is dependent on factors like the patient’s muscle mass and fluid status (fluid can either cause dilution and therefore artificially decrease the serum creatinine concentration or cause renal venous congestion and therefore increase it). Serum cystatin C concentration has been shown as a reliable predictor of all-cause AKI, with an area under the curve (AUC) of 0.89, 82% sensitivity, 82% specificity. NGAL is another prospective biomarker, predicting type I cardiorenal syndrome with an AUC of 0.875, 95% sensitivity and 81.2% specificity and has shown even better performance when combined with other biomarkers like creatinine or NT-proBNP (AUC 0.917, 92.5% sensitivity, 80% specificity). Several cutoff values for NGAL have been proposed: a group of authors found that serum NGAL concentrations above the cutoff value of 134 ng/mL predict worsened kidney function (AUC 0.83, 92% sensitivity, 71% specificity), while another found that urinary NGAL concentrations above the cutoff value of 12ng/mL were predictive of AKI with 79% sensitivity and 67% specificity. Conclusion Cystatin C and NGAL (both serum and urinary) have been demonstrated by a number of studies as superior to serum creatinine alone for the diagnosis of AKI in heart failure patients or have been shown to improve the diagnostic accuracy of serum creatinine when used in conjunction with it. More attention should be paid to using these biomarkers in both diagnosing and predicting the development of AKI in hospitalized heart failure patients.

Acute Kidney Injury ; Biomarkers ; Cardiorenal Syndrome

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