Acute kidney injury (AKI) in hospitalized patients is independently associated 
with increased morbidity and mortality in pediatric and adult populations. 
Continued reliance on serum creatinine and urine output to diagnose AKI has 
resulted in our inability to provide successful therapeutic and supportive 
interventions to prevent and mitigate AKI and its effects. Research efforts over 
the last decade have focused on the discovery and validation of novel urinary 
biomarkers to detect AKI prior to a change in kidney function and to aid in the 
differential diagnosis of AKI. The aim of this article is to review the AKI 
biomarker literature with a focus on the context in which they should serve to 
add to the clinical context facing physicians caring for patients with, or 
at-risk for, AKI. The optimal and appropriate utilization of AKI biomarkers will 
only be realized by understanding their characteristics and placing reasonable 
expectations on their performance in the clinical arena.