Research » Acute Kidney Injury

Acute kidney injury (AKI), previously called acute renal failure, has been estimated to affect 120,000- 750,000 people per year in the UK and is increasing worldwide. This mostly occurs as a complication of acute illness e.g sepsis, hypovolaemia, or following major surgery or through nephrotoxic drugs/ media. The resultant cellular injury is most commonly acute tubular necrosis. Approximately 20% of patients admitted acutely to hospital will develop some degree of AKI.

Image source: Wellcome Images (David Gregory & Debbie Marshall)

Consequences are major, including worse short and long term outcomes with the risk of death at least doubling, increased need for critical care and increased risk of chronic kidney disease. Preventing even 30% of cases in the UK would save the NHS £130 million to £186 million per year. It has been estimated by the National Confidential Enquiry into Patient Outcomes and Death in the Adding Insult to Injury report that at least 20% of these cases are avoidable given better care and management. The Department of Health Acute Kidney Injury Delivery Group has now been established with AKI recognised as an NHS priority.

A key element in reducing risk or in diagnosing AKI earlier and facilitating earlier and appropriate therapeutic intervention is the use of biomarkers. Serum creatinine is the current "gold standard" biomarker used for monitoring renal function but is relatively insensitive and not specific for AKI. Newer emerging markers include kidney injury molecule-1 (KIM-1), interleukin 18 (IL-18), cystatin C, liver fatty acid binding protein (L-FABP) and neutrophil gelatinase associated lipocalin (NGAL) although further studies are needed to determine their clinical utility.

A focus of the Group is in using proteomic techniques to identify and validate potential new biomarkers which may be measured non-invasively in urine and plasma/serum and provide sensitive and specific indicators predicting, diagnosing or monitoring patients with AKI.

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