Biomarkers in Pediatric Acute Kidney Injury

Serum creatinine and urine output are imprecise and unreliable measures of structural acute kidney injury (AKI). Novel non-invasive structural AKI biomarkers improve diagnostic and therapeutic patient care by allowing earlier detection of tissue injury at a time when inciting factors can still be modified and response to interventions trended in real-time. Neutrophil gelatinase-associated lipocalin (NGAL) is the most well-established AKI biomarker, validated in pediatric populations, and is already being employed effectively in the clinical setting using widely available standardized clinical platforms. AKI risk, severity stratification, and prognosis are dose-dependent and can be trended in real-time using categories based on urine or plasma NGAL levels: low risk <50 ng/mL, equivocal 50-150 ng/mL, moderate risk 150-300 ng/mL, and high risk >300 ng/mL.