Appropriate patient population ICU patients ≥ 21 years of age with: one other risk factor for AKI post cardiac bypass or other major high-risk surgery sepsis

Appropriate use On admission to ICU or sudden deterioration of a critically ill patient Can be used in conjunction with furosemide stress test

Unapproved uses and limitations Patients under the age of 21 Ambulatory setting Minor surgery Low-risk patients in the hospital and emergency department In patients with established KDIGO stage 2 and 3 AKI Daily or serial measurement As a substitute for serum creatinine measurement Proteinuria: urine albumin > 125 mg/dL interferes with the result; >3000 mg/dL invalidates it Bilirubinuria: urine bilirubin concentrations > 7.2 g/dL interfere with the result Turnaround time is approximately 30 to 60 minutes

Implications of positive test (>0.3) Test should be interpreted along with other clinical factors High risk for KDIGO stage 2 or 3 AKI within 12 hours (27% absolute risk) Consider nephrology consultation Consider preventive strategies: optimize volume status and hemodynamics, avoid nephrotoxins, closer monitoring of urine output

TIMP-2: tissue inhibitor of metalloprotease 2; IGFBP7: insulin-like growth factor binding protein 7; ICU: intensive care unit; AKI: acute kidney injury; KDIGO: Kidney Disease: Improving Global Outcomes