Methods and compositions for diagnosis and prognosis of renal injury and renal failure
The present invention relates to methods and compositions for monitoring, diagnosis, prognosis, and determination of treatment regimens in subjects suffering from or suspected of having a renal injury. In particular, the invention relates to using a plurality of assays, one or more of which is configured to detect a kidney injury marker selected from the group consisting of Hyaluronic acid, Immunoglobulin A, Immunoglobulin G1, Immunoglobulin G2, Insulin-like growth factor-binding protein 7, Alpha-1 antitrypsin, Serum amyloid P component, Metalloproteinase inhibitor 2, Hepatocyte growth factor, Intercellular adhesion molecule 1, Beta-2-glycoprotein 1, Interleukin-1 beta, Neutrophil Elastase, Tumor necrosis factor receptor superfamily member HB, Interleukin-11, Cathepsin D, C-C motif chemokine 24, C-X-C motif chemokine 6, C-C motif chemokine 13, C-X-C motif chemokines-1, -2, and -3, Matrilysin, Interleukin-2 receptor alpha chain, Insulin-like growth factor-binding protein 3, and Macrophage colony-stimulating factor 1 as diagnostic and prognostic biomarkers in renal injuries.
1. A method of treating a subject having an increased risk of experiencing a detrimental outcome related to a renal injury, the method comprising:
correlating an assay result measuring levels of kidney injury markers in one or more body fluid samples obtained from the subject to an increased risk of experiencing a detrimental outcome related to a renal injury when the assay result is above a predetermined threshold, wherein the kidney injury markers comprise Insulin-like growth factor-binding protein 7 (IGFB7) and Metalloproteinase inhibitor 2 (TIMP2) and the assay result combines the levels of the kidney injury markers into a single composite result;
treating the subject having an increased risk of experiencing a detrimental outcome related to a renal injury with a compatible treatment, wherein the compatible treatment comprises one or more of initiating renal replacement therapy, withdrawing delivery of compounds that are known to be damaging to the kidney, delaying procedures that are known to be damaging to the kidney and modifying diuretic administration.
2. The method of claim 1 , wherein the risk of experiencing a detrimental outcome related to a renal injury comprises a risk of needing renal replacement therapy, a risk of requiring withdrawal of renal toxins, a risk of progressing to a worsening stage of AKI, a risk of end stage renal disease, a risk of a major adverse cardiac event, a risk of developing chronic kidney disease, or a risk of death.
3. The method of claim 1 , wherein the subject has been staged as not having acute kidney injury.
4. The method of claim 1 , wherein the subject has been staged as having RIFLE stage R or AKIN stage I acute kidney injury.
5. The method of claim 4 , wherein the subject meets only the serum creatinine criteria of RIFLE stage R or AKIN stage I acute kidney injury.
6. The method of claim 4 , wherein the subject meets only the urine output criteria of RIFLE stage R or AKIN stage I acute kidney injury.
7. The method of claim 4 , wherein the subject meets both the serum creatinine and the urine output criteria of RIFLE stage R or AKIN stage I acute kidney injury.
8. The method of claim 1 , wherein the subject has been staged as having RIFLE stage I or AKIN stage II acute kidney injury.
9. The method of claim 8 , wherein the subject meets only the serum creatinine criteria of RIFLE stage I or AKIN stage II acute kidney injury.
10. The method of claim 8 , wherein the subject meets only the urine output criteria of RIFLE stage I or AKIN stage II acute kidney injury.
11. The method of claim 8 , wherein the subject meets both the serum creatinine and the urine output criteria of RIFLE stage I or AKIN stage II acute kidney injury.
12. The method of claim 1 , wherein the subject has been staged as having RIFLE stage F or AKIN stage III acute kidney injury.
13. The method of claim 12 , wherein the subject meets only the serum creatinine criteria of RIFLE stage F or AKIN stage III acute kidney injury.
14. The method of claim 12 , wherein the subject meets only the urine output criteria of RIFLE stage F or AKIN stage III acute kidney injury.
15. The method of claim 12 , wherein the subject meets both the serum creatinine and the urine output criteria of RIFLE stage F or AKIN stage III acute kidney injury.
16. The method of claim 1 , wherein the single composite result is a concentration of IFGBP7multiplied by a concentration of TIMP2.
17. The method of claim 1 , wherein the body fluid sample is a urine sample.
18. The method of claim 1 , wherein the risk of experiencing a detrimental outcome related to a renal injury is a risk of experiencing the detrimental outcome within 7 days.
19. The method of claim 1 , wherein the subject is selected for evaluation based on the pre-existence in the subject of one or more known risk factors for prerenal, intrinsic renal, or post renal acute kidney injury.
20. The method of claim 1 , wherein the subject is selected for evaluation based on an existing diagnosis of one or more of congestive heart failure, preeclampsia, eclampsia, diabetes mellitus, hypertension, coronary artery disease, proteinuria, renal insufficiency, glomerular filtration below the normal range, cirrhosis, serum creatinine above the normal range, aneurism, chronic lung disease, acute lung injury, HIV infection, volume depletion, hypotension, shock, sepsis, injury to renal function, reduced renal function, or acute kidney injury; or based on undergoing or having undergone major vascular surgery, coronary artery bypass, or other cardiac surgery; or based on previous or anticipated exposure to one or more nephrotoxic agents; or based on one or more risk scores.