Healio: Biomarker may predict AKI following common medical procedures

By Melissa J. Webb

Higher levels of a signaling glycoprotein were associated with acute kidney injury in patients who underwent coronary angiography or cardiac surgery, according to study results.

In a press release, primary investigator Salim S. Hayek, MD, of the University of Michigan, said, “[Soluble urokinase plasminogen activator receptor] suPAR reflects a process that physicians are unable to account for in traditional assessments of kidney disease. We believe this protein acts as the link between inflammation and kidney disease, both chronic and acute.”

Writing that AKI most commonly occurs in critically ill patients or in those with cardiovascular disease — as members of these populations are at increased risk due to older age, coexisting conditions and greater likelihood of undergoing medical procedures that affect the kidneys — Hayek and colleagues wanted to explore new therapeutic targets that could be used in preventive strategies.

The new findings from Hayek et al lead to the growing body of evidence surrounding the predictive ability of soluble urokinase plasminogen activator receptor (suPAR) and kidney disease, although this particular study further investigates the understudied relationship between suPAR and acute kidney injury. Previous studies by this group and others have shown an association between the prognostic ability of suPAR to predict the development of incident chronic kidney disease, and also is associated with more rapid progression of CKD. In this study, the authors found that higher suPAR levels were consistently associated with increased risk for subsequent AKI events in three different cohorts of high-risk adult patients undergoing coronary angiography, cardiac surgery and adults in intensive care unit with critical illness.

What is perhaps most notable about this tantalizing study is the early experimental evidence using a targeted monoclonal antibody that may one day serve as a possible therapeutic target. This is sorely needed in the current era of stagnant research progress in the field of AKI, which has mainly shown disappointing potential therapeutic interventions such as acetylcysteine, sodium bicarbonate and saline hydration. This important work also adds novel insights into the growing awareness of the continuum of acute kidney injury to chronic kidney disease.

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