The concept of risk and the value of novel markers of acute kidney injury.

Kashani and colleagues studied two novel markers, insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinases-2, in the urine of patients at high risk of acute kidney injury (AKI). They validated these markers in a separate large multicenter study and compared them with known markers of AKI such as neutrophil gelatinase-associated lipocalin and kidney injury molecule-1. Insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinases-2 performed better than other known markers and their combination provided additional information. These markers could be useful in clinical practice to uncover silent episodes of AKI or to make an early identification of patients at risk. Ultimately they could help to detect and possibly prevent episodes of acute injury to the kidney, sometimes referred to as kidney attack.