NephroCheck: should we consider urine osmolality?

Excerpt

Early detection of acute kidney injury (AKI) is challenging due to the risk of morbidity and mortality and a direct impact on patients’ management [1]. The diagnosis relies on the changes of serum creatinine and urine output [2], which are the main markers of kidney function. Recently, Astute Medical introduced the NephroCheck, a test that allows a bedside analysis of two biomarkers of renal damage implicated in G1 cell-cycle arrest: tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) [3]. The combination of these two biomarkers led to a new score (AKIRisk™). An AKIRisk™ score > 0.3 identifies patients at risk of developing AKI with sensitivity and specificity of 92% and 46%, respectively; increasing the cutoff to 2.0, the sensitivity is 46% and the specificity is 95% [4]. The AKIRisk™ reference interval in healthy humans ranges from 0.04 to 2.22. A possible reason for this wide range could be that the score is not taking into account urine concentration. …