Urinary biomarkers at hospital admission and community-acquired acute kidney injury: A prospective cohort
In brief
Four urine biomarkers detected only 23% to 33% of admission kidney injury cases
In this prospective study of 731 adults admitted through the emergency department, 26% had community-acquired acute kidney injury. Four urine biomarkers were more often elevated in affected patients, but their low sensitivity and near-chance discrimination limit their usefulness as stand-alone tests; whether they add meaningful value to clinical assessment remains unclear.
- Journal
- American journal of nephrology (Q1)
- Published
- 16 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Farid Samaan, Flávia Barros de Azevedo, Dirce Maria Trevisan Zanetta, Luis Yu, Irineu Tadeu Velasco, Lia Junqueira Marçal, et al.
- PMID
- 42886603
- DOI
- 10.1159/ajn/ablag026
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 18 October 2026): Urinary biomarkers for acute kidney injury detection
Abstract
BACKGROUND: We aimed to determine the sensitivity and specificity of a 13-urinary biomarker (uBM) panel for identifying community-acquired acute kidney injury (CA-AKI) and to assess whether these biomarkers were independently associated with CA-AKI. METHODS: This prospective observational study was conducted at a tertiary care hospital. Adults admitted through the emergency department were included. CA-AKI was defined as a ≥0.3 mg/dl decrease in serum creatinine (SCr) within 48 hours or a ≥50% decrease within 7 days. Blood samples were collected daily for SCr measurement, and urine samples were obtained at admission for uBM assessment. All the uBM were classified as abnormal when they exceeded the 75th percentile of the distribution. RESULTS: 731 patients were included (55% male, median age of 61 years; 48% had hypertension, 28% had diabetes mellitus, and 23% had heart failure). The main reasons for hospitalization were respiratory (32%), genitourinary (15%), and cardiovascular (11%) diseases. CA-AKI was diagnosed in 26% of the patients. Compared with patients without CA-AKI, those with CA-AKI showed higher rates of elevation in four uBM: KIM-1 (31% vs. 23%; p=0.032), TIMP-2*IGFBP-7 (30% vs. 23%; p=0.045), clusterin (32% vs. 22%; p=0.011), and MCP-1 (33% vs. 22%; p=0.003). The sensitivity and specificity of uBM for detecting CA-AKI ranged from 23% to 33% and from 74% to 78%, respectively, and the area under the receiver operating characteristic curve (AUC) ranged from 0.485 to 0.554. Logistic regression analyses identified conditions independently associated with CA-AKI, including: hypotension [OR (95% CI): 2.07 (1.33-3.23); p=0.001], dehydration [OR (95% CI): 2.01 (1.40-2.91); p<0.001], chronic kidney disease [OR (95% CI): 2.00 (1.19-3.35); p=0.009], genitourinary tract disease [OR (95% CI): 2.00 (1.26-3.10); p=0.003], chronic liver disease [OR (95% CI): 1.69 (1.09-2.61); p=0.018], and elevation of one or more of the following uBM: KIM-1, TIMP-2*IGFBP-7, clusterin, and MCP-1 [OR (95% CI): 1.51 (1.06-2.14); p=0.022]. CONCLUSION: The expression of one or more of four uBM at emergency department admission (KIM-1, TIMP-2*IGFBP-7, clusterin, and MCP-1) may help identify patients with a higher probability of having CA-AKI, even with modest AUC results.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.