Ep70: Zeroing in on “the renal troponin”

Acute Kidney Injury makes a greater contribution to early mortality than acute myocardial infarction and it's been argued we should consider the concept of “kidney attack” to give it the weight that it deserves. But the presentation of kidney injury isn’t as overt or timely as a heart attack often is. 

While serum creatinine is a pretty good reporter of chronic impairment in kidney function it’s very insensitive to acute injury, so for two decades there’s been a concerted search for more proximal biomarkers of AKI. 

The three most promising candidates are neutrophil gelatinase‐associated lipocalin (NGAL), tissue inhibitor of metallo-proteinase 2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGBFP-7). Commercial assays for these exist that can predict moderate to severe AKI with a lead time of many hours in at-risk patients. 

But many questions remains as whether these are specific enough to be useful at point of care whether we have the interventions to respond to the information they provide, and what ‘false positives’ might indicate.

Guest
Professor Rinaldo Bellomo AO FRACP FCICM FAHMS (Director of Research Intensive Care, Austin Hospital; University of Melbourne; Monash University).
author of “Novel renal biomarkers of acute kidney injury and their implications” (2021) Internal Medicine Journal 51;3 pp316-318

Production
Written and produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Downhill Racer’, by Blue Dot Sessions, ‘Making a Change’ by Lee Rosevere, ‘Fryeri’ by Kai Engel, ‘Subscribe to the New Internationalist’ by Tzara. Music licenced from Epidemic Sound includes 'Let Us Overcome' by Tayler Watts. Image licensed from Getty Images.

Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Paul Cooper, Rhiannon Mellor, Duncan Austin, Seema Radhakrishnan, Phillipa Wormald, Victoria Langton,  Oliver Dillon and Loryn Einstein.  

Please visit the RACP website for a transcript and supporting references. Fellows of the College can claim CPD credits for listening and additional reading.