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Traditional methods used to evaluate changes in kidney function to identify acute kidney injury (AKI) have significant limitations. Damage biomarkers can identify patients at risk for AKI prior to changes in kidney function. While clinical trials have shown that biomarker-guided treatment can improve outcomes, whether these biomarkers can influence providers’ choice of treatment strategy for risk prediction, surveillance, or diagnostic evaluation in clinical practice is uncertain.


This case series describes 4 patients at an Academic medical center whose care was informed by kidney biomarker utilization in conjunction with a clinical decision support system (CDSS). Though each patient’s clinical presentation was unique, kidney biomarkers were successfully employed as clinical tools in evaluating the risks and benefits of nephrotoxic medications.


This case series demonstrates 4 scenarios in which a kidney injury biomarker used in conjunction with CDSS and consideration of the patients’ clinical presentation informed treatment strategies with the intent to prevent AKI.


acute kidney injury; biomarkers; clinical decision support systems; implementation; insulin-like growth factor–binding protein 7; medication safety; tissue inhibitor of metalloproteinases 2.

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Case presentations of medication management for patients at risk for drug-associated acute kidney injury identified with a CDS system and a novel biomarker

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