BUN and serum creatinine are not very sensitive and specific markers for the diagnosis of AKI as they are influenced
by many renal and non-renal factors independent of kidney function. IL-18 is released into the urine by the injured
kidney, analogous to the troponin release by injured myocardial cells after myocardial infarction, and is a more sensitive
and specific early marker of AKI than BUN and serum creatinine. The most recent data on urine IL-18 comes from
the Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) study. In 311 children
and 1219 adults, urine IL-18 was increased in the first 6 hours after cardiac surgery in AKI patients that later developed
a doubling of serum creatinine or the need for dialysis. In 2006, a patent was issued to inventors Charles L. Edelstein
and Chirag R. Parikh entitled “Methods for detection of IL-18 as an early marker for the diagnosis of acute renal failure
and predictor of mortality”. In addition to IL-18, patents have been issued for neutrophil gelatinase-associated lipocalin
(NGAL), kidney injury molecule 1 (KIM-1), Netrin-1, Gro-alpha (also known as CXCL1), heat shock protein-72, mannose-
binding lectin (MBL), urinary cytokines and chemokines, aprotinin, and microalbumin as early diagnostic biomarkers
of AKI. Also, there is a patent application for using proteomics for the discovery of biomarkers for the early detection
of renal disease.
Keywords: Acute kidney injury, biomarker, interleukin-18, ischemic AKI, HMGB1, Interstitial inflammation, Cytokines, nephrotic syndrome, urinary tract infections.
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