{"id":"77cb31e71170","type":"article","url":"https://hartvaat.nl/2026/10/16/urinaire-biomarkers-bij-opname-helpen-bij-het-opsporen-van-ca-aki-prospectief-co/","title":"Urinaire biomarkers bij opname helpen bij het opsporen van CA-AKI — prospectief cohort","title_en":"Urinary biomarkers at hospital admission and community-acquired acute kidney injury: A prospective cohort.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"American journal of nephrology","doi":"10.1159/ajn/ablag026","source_url":"https://doi.org/10.1159/ajn/ablag026","authors":["Farid Samaan","Flávia Barros de Azevedo","Dirce Maria Trevisan Zanetta","Luis Yu","Irineu Tadeu Velasco","Lia Junqueira Marçal","Leila Antonangelo","Emmanuel A Burdmann"],"significance":4,"published":"2026-10-25","source_date":"2026-10-16","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"In a prospective cohort of 731 emergency department patients, four urinary biomarkers (KIM-1, TIMP-2*IGFBP-7, clusterin, and MCP-1) were associated with community-acquired acute kidney injury (CA-AKI), which occurred in 26% of participants. The biomarkers showed low sensitivity (23–33%) but moderate specificity (74–78%), with AUC values ranging from 0.485 to 0.554. Independent predictors of CA-AKI included hypotension, dehydration, and pre-existing chronic kidney disease, alongside elevated biomarker levels. These findings suggest that admission urinary biomarkers may help identify patients at higher risk of CA-AKI, though their standalone predictive value remains modest.","created":"2026-10-18T01:13:48Z","updated":"2026-10-18T01:13:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een prospectief cohort van 731 patiënten op de spoedeisende hulp bleek een panel van vier urinaire biomarkers (KIM-1, TIMP-2*IGFBP-7, clusterin en MCP-1) geassocieerd met het voorkomen van community-acquired acute kidney injury (CA-AKI), dat bij 26% van de patiënten werd vastgesteld. De sensitiviteit van de biomarkers was laag (23–33%), maar de specificiteit lag rond de 74–78%, met AUC-waarden tussen 0,485 en 0,554. Naast de biomarkers waren hypotensie, uitdroging en een bestaande nierfunctiestoornis onafhankelijk geassocieerd met CA-AKI. De bevindingen suggereren dat deze biomarkers een aanvullende rol kunnen spelen bij het identificeren van patiënten met een verhoogd risico op AKI bij ziekenhuisopname, hoewel de voorspellende waarde beperkt blijft.","abstract_original":"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."}