BIOMARKERS AND EARLY DIAGNOSIS IN ACUTE KIDNEY INJURY
ACUTE KIDNEY INJURY, Kültigin Türkmen, Editör, Türkiye Klinikleri Yayınevi, İstanbul, ss.49-61, 2026
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2026
- Doi Numarası: 10.5336/978-625-5439-01-7_p49
- Yayınevi: Türkiye Klinikleri Yayınevi
- Basıldığı Şehir: İstanbul
- Sayfa Sayıları: ss.49-61
- Editörler: Kültigin Türkmen, Editör
- Gazi Üniversitesi Adresli: Evet
Özet
Acute kidney injury (AKI) is a common and clinically significant syndrome associated with substantial short-term morbidity and mortality, as well as an increased risk of long-term adverse outcomes, including chronic kidney disease and end-stage kidney disease among survivors. Despite its clinical importance, early diagnosis of AKI remains challenging. Conventional diagnostic markers, namely serum creatinine and urine output, primarily reflect functional impairment rather than structural kidney damage and often change only after a significant delay. As a result, early or “subclinical” AKI-characterized by ongoing tubular injury and cellular stress in the absence of detectable changes in creatinine-may remain unrecognized, limiting opportunities for timely intervention. In recent years, considerable advances have been made in the identification and characterization of novel biomarkers that provide insight into the underlying pathophysiological processes of AKI. These biomarkers reflect distinct yet complementary mechanisms, including tubular injury, inflammation and immune activation, cellular stress and repair responses, alterations in glomerular filtration, and oxidative stress. This chapter summarizes the biological rationale for biomarker use in AKI and provides a comprehensive overview of the most extensively studied and emerging biomarkers within these categories. Accumulating evidence suggests that the use of multiple biomarkers in combination may offer superior diagnostic and prognostic performance compared to single-marker approaches, particularly in complex clinical settings such as sepsis, cardiothoracic surgery, and critical illness. These multimarker strategies have the potential to improve early detection, enhance risk stratification, and guide clinical decision-making by capturing the multifactorial nature of AKI pathophysiology. However, despite promising results, several challenges hinder the routine clinical implementation of AKI biomarkers. Variability in sampling timing, measurement techniques, and threshold values, along with heterogeneity in patient populations, contribute to inconsistencies across studies and limit generalizability. Therefore, further research is required to establish standardized measurement protocols, validate clinically meaningful cutoff values, and assess biomarker performance in large, prospective, multicenter cohorts. Future directions should also focus on integrating biomarker data with clinical risk models and emerging technologies such as artificial intelligence-based decision support systems. Such approaches may facilitate earlier detection of AKI, enable personalized risk assessment, and ultimately improve patient outcomes through timely and targeted interventions.