Proteornics for the investigation of acute kidney injury

Acute kidney injury (AKI), previously referred to as acute renal failure (ARF), represents an important problem in clinical medicine. Despite significant improvements in therapeutics, the mortality and morbidity associated with AKI remain high. The reasons for this include (a) an incomplete understanding of the underlying pathophysiologic mechanisms, and (b) the lack of early markers for AKI, and hence an unacceptable delay in initiating therapy. Fortunately, the application of innovative technologies such as functional genomics and proteomics to human and animal models of AKI has uncovered several novel genes and proteins that are emerging as biomarkers and novel therapeutic targets. Recent advances in proteomics that hold promise in ischemic AKI, the most common and serious subtype of ARF, are chronicled in this article. These include the identification of biomarkers in the plasma (NGAL and cystatin C) and urine (NGAL, KIM-1, IL-18, cystatin C, alpha(1)-microglobulin, fetuin-A, Gro-alpha, and meprin) for the investigation of AKI. It is likely that the AKI panels will be useful for timing the initial insult and assessing the duration of AKI. Based on the differential expression of the biomarkers, it is also likely that the AKI panels will distinguish between the various etiologies of AKI, and predict clinical outcomes. Copyright (c) 2008 S. Karger AG, Basel.