Les nouveaux marqueurs biologiques de l'insuffisance rénale aiguë

Acute kidney injury (AKI) is frequent in the intensive care unit and is associated with a high morbi-mortality. The only effective treatment, except renal replacement therapy, is based on AKI prevention by optimization of therapeutics that limit the effects of the identified risk factors associated with AKI: low blood pressure, hypovolemia, sepsis, drug toxicity, anemia … The diagnosis of AKI is based on the analysis of markers such as serum creatinine and diuresis to appreciate the glomerular filtration rate and to allow to estimate renal function according to RIFLE classification. However these markers have a poor sensitivity and specificity, and changes of these criteria are often too late to allow practicians to optimize therapeutics that could prevent AKI. During the last years, numerous works focusing on the idenfication of new serum or urinary biomarkers of AKI have been published in the literature. To date, if no marker have reached accurate sensitivity/specificity to predict AKI, such as troponin for the diagnosis and prognosis of acute myocardial infarction, some of them, such as interleukine-18 (Il-18), neutrophil gelatinase-associated lipocalin (NGAL) and cystatine C offer encouraging perspectives for the future. The purpose of this article is to review the scientific headways in the field of research for the new biomarkers of AKI.