Clin Chem Lab Med. 2026 Jul 9. doi: 10.1515/cclm-2026-0626. Online ahead of print.
ABSTRACT
OBJECTIVES: Identification of acute kidney injury (AKI) in neonatology and paediatrics continues to present challenges to laboratories. Emerging biomarkers are being developed which may offer early detection but haven’t been adopted in current guidelines yet. The aim of this IFCC survey was to characterise current laboratory practices in paediatric settings and identify key drivers and barriers to implementing emerging biomarkers in routine practice.
METHODS: A twelve-question survey was distributed by the International Federation of Clinical Chemistry and Laboratory Medicine’s Committee of Emerging Technologies in Paediatric Laboratory Medicine to 10 member countries in North America and Europe to assess the current state of AKI identification in laboratory medicine.
RESULTS: 180 responses were received from seven countries. Only 20 % reported AKI staging. 52.7 % of laboratories used the recommended enzymatic creatinine method with only 32 % using an age-related reference interval. 19 laboratories had introduced novel biomarkers into practice with Cystatin-C (12) and neutrophil gelatinase-associated lipocalin (NGAL) (5) being the most popular.
CONCLUSIONS: This survey demonstrates substantial variation in laboratory approaches to AKI identification in neonatal and paediatric settings with limited use of AKI staging and inconsistent use of age-appropriate creatinine reference intervals. The lack of neonatal and gestational age-dependent creatinine reference intervals remains a key barrier to reliable neonatal AKI diagnosis. While a minority of laboratories have implemented emerging biomarkers (most commonly cystatin C and NGAL), wider adoption is constrained by assay availability, cost and absence of clear guidance. These findings highlight priority areas for harmonisation and guideline development to support evidence-based implementation of emerging biomarkers in routine practice.
PMID:42415250 | DOI:10.1515/cclm-2026-0626