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Table 1 [TIMP-2]•[IGFBP7] Protocol* Evaluation of existing clinical protocols: ranked order of actions and avoidances† by risk for AKI

From: Clinical use of [TIMP-2]•[IGFBP7] biomarker testing to assess risk of acute kidney injury in critical care: guidance from an expert panel

Actions/avoidances   Actions/avoidances   Actions/avoidances  
Low risk (≤ 0.3) Count High risk (> 0.3, ≤ 2.0) Count Highest risk (> 2) Count
Standard of care 13 No NSAIDs/ACE inhibitors/ARBs 20 Avoid aminoglycosides 6
Remove Foley 11 Keep/insert Foley 19 Renal ultrasound 5
Daily SCr 10 Hourly UO 19 Monitor SVV/Cardiac Index/SVO2 Q8–12 5
No HD monitoring 9 SCr Q8–12 19 Monitor fluid resuscitation 5
Recheck in 12 h if new insult 7 Avoid contrast 19 Maintenance fluids 5
Daily serum BUN 6 Consider/do renal consult 16 Send urine Na+, urea, creatinine 4
May use NSAIDs/ACE inhibitors 6 Recheck in 8–24 h 14 Check IVC compressibility with ultrasound 4
Diurese if signs of volume overload 6 Minimize/avoid nephrotoxins 13 Consider/use norepinephrine, epinephrine 4
SVO2 not monitored 5 Consider/use inotropes 11 Vasopressors 4
Mean hourly UO 4 Hold Lasix unless pulmonary edema 11 Dobutamine/Milrinone 4
Consider transfer out of ICU 4 Adjust medication dosing 10 Avoid multiple pressors 4
Consider/do hemodynamic monitoring 9 Sensible fluids 4
Adjust narcotics doses 9 Avoid and resolve hypervolemia (> 10% fluid gain) 4
Consider colloids-only approach 9 Maintain SBP > 90 3
Keep MAP > 65–80 8 Keep MAP ± 10% baseline 3
Serum BUN Q12 7 Consider higher transfusion trigger 3
Monitor SVO2 if history of abnormal liver function 7 PA catheter 3
IVF expansion 7 Avoid piperacillin-tazobactam 3
May use balanced fluid if CVP < 8 and hypovolemic 7 Low threshold for inotropes if Cardiac Index < 2, ScvO2 < 70, and/or LA increasing despite adequate MAP and volume expansion 3
Pharmacy consult 7 Goal SVV < 14 2
Urine Na, Cr, Eos ×1 6 Diuretics and fluids to be utilized only after determining fluid status and need with FloTrac, ultrasound, etc. 2
Goal CI > 2.0–2.2 6 Assess fluid responsiveness 2
Avoid vancomycin 6   
  1. *25 [TIMP-2]•[IGFBP7] protocols evaluated. †Actions/avoidances included in ≥ 2 protocols. ACE angiotensin-converting enzyme, AKI acute kidney injury, ARB angiotensin-receptor blocker, BUN blood urea nitrogen, Cr creatinine, CVP central venous pressure, Eos eosinophils, HD hemodialysis, ICU intensive care unit, IVC inferior vena cava, IVF intravenous fluid, MAP mean arterial pressure, Na sodium, NSAID nonsteroidal anti-inflammatory drug, PA pulmonary artery, SBP systolic blood pressure, SCr serum creatinine, SVO2 venous oxygen saturation, UO urinary output, SVV stroke volume variation