NZ621716B2 - Methods and compositions for diagnosis and prognosis of renal injury and renal failure - Google Patents

Abstract

Disclosed is a method for evaluating renal status in a subject ex vivo, comprising: performing one or more assays configured to detect one or more biomarkers in a body fluid sample obtained previously from the subject to provide an assay result, wherein at least one of the markers is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex; and correlating an assay result(s) to the renal status of the subject. collagenase:Metalloproteinase inhibitor 2 complex; and correlating an assay result(s) to the renal status of the subject.

Description

METHODS AND COMPOSITIONS FOR DIAGNOSIS AND PROGNOSIS OF RENAL INJURY AND RENAL FAILURE The present application claims priority to provisional US. patent application 61/528,000 filed August 26, 2011, and to provisional US. patent application 61/528,003 filed August 26, 2011, which is hereby incorporated in its entirety including all tables, figures, and claims.

OUND OF THE INVENTION The following discussion of the background of the invention is merely provided to aid the reader in tanding the invention and is not admitted to describe or constitute prior art to the t invention.

The kidney is responsible for water and solute excretion from the body. Its functions include maintenance of acid-base balance, regulation of electrolyte concentrations, control of blood , and regulation of blood pressure. As such, loss of kidney function through injury and/or disease results in substantial morbidity and mortality. A detailed discussion of renal injuries is provided in Harrison’s Principles of Internal Medicine, 17th Ed., McGraw Hill, New York, pages 1741-1830, which are hereby incorporated by reference in their entirety. Renal disease and/or injury may be acute or chronic. Acute and chronic kidney disease are described as follows (from Current Medical Diagnosis & Treatment 2008, 47th Ed, McGraw Hill, New York, pages 5, which are hereby incorporated by reference in their entirety): “Acute renal failure is worsening of renal function over hours to days, resulting in the retention of nitrogenous wastes (such as urea en) and creatinine in the blood. Retention of these nces is called azotemia. c renal failure (chronic kidney disease) results from an abnormal loss of renal function over months to years”.

Acute renal failure (ARF, also known as acute kidney injury, or AKI) is an abrupt (typically detected within about 48 hours to 1 week)reduction in glomerular filtration. This loss of filtration capacity results in ion of nitrogenous (urea and nine) and non-nitrogenous waste products that are normally excreted by the , a reduction in urine output, or both. It is reported that ARF complicates about 5% of hospital admissions, 4-15% of cardiopulmonary bypass surgeries, and up to 30% of intensive care admissions. ARF may be categorized as prerenal, intrinsic renal, or postrenal in causation. Intrinsic renal disease can be further divided into glomerular, tubular, interstitial, and vascular abnormalities. Maj or causes of ARF are described in the ing table, which is adapted from the Merck Manual, l7th ed., Chapter 222, and which is hereby incorporated by reference in their entirety: T e Risk Factors ECF volume depletion ive diuresis, hemorrhage, GI losses, loss of intravascular fluid into the extravascular space (due to ascites, peritonitis, pancreatitis, or , loss of skin and mucus membranes, renal salt- and water-wasting states Low cardiac output Cardiomyopathy, MI, cardiac tamponade, pulmonary embolism, pulmonary hypertension, positive-pressure mechanical ventilation Low systemic vascular Septic shock, liver failure, antihypertensive drugs resistance Increased renal vascular NSAIDs, cyclosporines, tacrolimus, hypercalcemia, resistance anaphylaXis, anesthetics, renal artery obstruction, renal vein thrombosis, sepsis, renal syndrome Decreased efferent ACE inhibitors or angiotensin II receptor rs arteriolar tone (leading to decreased GFR from reduced glomerular transcapillary pressure, especially in patients with bilateral renal artery Acute tubular injury Ischemia (prolonged or severe prerenal state): surgery, hemorrhage, arterial or venous obstruction; Toxins: NSAIDs, cyclosporines, tacrolimus, aminoglycosides, foscarnet, ethylene glycol, hemoglobin, myoglobin, ifosfamide, heavy metals, methotrexate, radiopaque contrast , streptozotocin Acute glomerulonephritis ANCA-associated: ntic glomerulonephritis, teritis nodosa, Wegener's granulomatosis; Anti- GBM glomerulonephritis: Goodpasture's syndrome; Immune-complex: Lupus glomerulonephritis, fectious ulonephritis, cryoglobulinemic glomerulonephritis Acute tubulointerstitial Drug on (eg, B-lactams, NSAIDs, sulfonamides, nephritis ciprofloxacin, thiazide diuretics, furosemide, oin, allopurinol, pyelonephritis, papillary necrosis Acute vascular Vasculitis, malignant hypertension, thrombotic nephropathy ngiopathies, scleroderma, atheroembolism Infiltrative diseases Lymphoma, sarcoidosis, leukemia Postrenal 2012/052298 Tubular precipitation Uric acid (tumor lysis), sulfonamides, triamterene, acyclovir, indinavir, methotrexate, ethylene glycol ingestion, myeloma protein, myoglobin Ureteral obstruction Intrinsic: i, clots, sloughed renal tissue, fungus ball, edema, malignancy, congenital defects; Extrinsic: Malignancy, retroperitoneal fibrosis, ureteral trauma during y or high impact injury Bladder obstruction Mechanical: Benign prostatic hyperplasia, prostate cancer, bladder cancer, urethral strictures, phimosis, imosis, al valves, obstructed indwelling urinary catheter; Neurogenic: Anticholinergic drugs, upper or lower motor neuron lesion In the case of ischemic ARF, the course of the disease may be divided into four phases. During an initiation phase, which lasts hours to days, reduced perfusion of the kidney is evolving into injury. Glomerular ultrafiltration reduces, the flow of filtrate is reduced due to debris within the tubules, and back leakage of filtrate through d epithelium occurs. Renal injury can be mediated during this phase by reperfusion of the kidney. Initiation is followed by an ion phase which is terized by continued ischemic injury and ation and may involve endothelial damage and vascular congestion. During the maintenance phase, lasting from 1 to 2 weeks, renal cell injury occurs, and glomerular filtration and urine output reaches a minimum. A recovery phase can follow in which the renal epithelium is repaired and GFR gradually recovers. Despite this, the survival rate of subjects with ARF may be as low as about 60%.

Acute kidney injury caused by radiocontrast agents (also called contrast media) and other toxins such as cyclosporine, antibiotics including aminoglycosides and anticancer drugs such as cisplatin sts over a period of days to about a week. Contrast induced nephropathy (CIN, which is AKI caused by radiocontrast agents) is thought to be caused by intrarenal vasoconstriction ng to ischemic injury) and from the generation of reactive oxygen species that are directly toxic to renal tubular epithelial cells. CIN classically presents as an acute (onset within ) but reversible (peak 3-5 days, tion within 1 week) rise in blood urea nitrogen and serum creatinine.

A commonly reported criteria for defining and detecting AKI is an abrupt (typically within about 2-7 days or within a period of hospitalization) elevation of serum creatinine. Although the use of serum creatinine elevation to define and detect AKI is well established, the magnitude of the serum creatinine elevation and the time over which it is ed to define AKI varies considerably among publications. Traditionally, relatively large increases in serum nine such as 100%, 200%, an increase of at least 100% to a value over 2 mg/dL and other definitions were used to define AKI. However, the recent trend has been towards using smaller serum creatinine rises to define AKI. The relationship between serum creatinine rise, AKI and the associated health risks are ed in Praught and Shlipak, Curr Opin Nephrol Hypertens 14:265-270, 2005 and Chertow et al, JAm Soc Nephrol 16: 3365-3370, 2005, which, with the references listed therein, are hereby incorporated by reference in their ty. As described in these publications, acute worsening renal function (AKI) and increased risk of death and other detrimental outcomes are now known to be associated with very small increases in serum creatinine. These ses may be determined as a relative nt) value or a nominal value. Relative ses in serum creatinine as small as 20% from the pre-injury value have been reported to indicate acutely worsening renal function (AKI) and increased health risk, but the more commonly reported value to define AKI and increased health risk is a relative increase of at least 25%. Nominal increases as small as 0.3 mg/dL, 0.2 mg/dL or even 01 mg/dL have been reported to indicate worsening renal on and increased risk of death. Various time s for the serum creatinine to rise to these threshold values have been used to define AKI, for example, ranging from 2 days, 3 days, 7 days, or a variable period defined as the time the patient is in the hospital or intensive care unit. These studies indicate there is not a particular threshold serum creatinine rise (or time period for the rise) for worsening renal function or AKI, but rather a continuous increase in risk with increasing magnitude of serum creatinine rise.

One study (Lassnigg et all, J Am Soc Nephrol 15:1597-1605, 2004, hereby incorporated by reference in its ty) investigated both increases and decreases in serum creatinine. Patients with a mild fall in serum creatinine of -0.1 to -0.3 mg/dL following heart surgery had the lowest mortality rate. Patients with a larger fall in serum nine (more than or equal to -0.4 mg/dL) or any increase in serum creatinine had a larger mortality rate. These findings caused the authors to conclude that even very subtle changes in renal function (as detected by small creatinine s within 48 hours of surgery) seriously effect patient’s es. In an effort to reach consensus on a unified classification system for using serum creatinine to define AKI in clinical trials and in clinical practice, Bellomo et (1]., Crit Care. 8(4):R204-l2, 2004, which is hereby WO 43310 incorporated by reference in its entirety, proposes the following fications for stratifying AKI ts: “Risk”: serum creatinine increased 1.5 fold from baseline OR urine production of <05 ml/kg body /hr for 6 hours; “Injury”: serum creatinine increased 2.0 fold from baseline OR urine production <0.5 ml/kg/hr for 12 h; “Failure”: serum creatinine increased 3.0 fold from baseline OR creatinine >355 umol/l (with a rise of >44) or urine output below 0.3 ml/kg/hr for 24 h or anuria for at least 12 hours; And included two clinical outcomes: “Loss”: persistent need for renal replacement therapy for more than four weeks.

“ESRD”: end stage renal e—the need for dialysis for more than 3 months.

These criteria are called the RIFLE criteria, which provide a useful clinical tool to classify renal status. As discussed in Kellum, Crit. Care Med. 36: S141-45, 2008 and Ricci et al., Kidney Int. 73, 538-546, 2008, each hereby incorporated by reference in its ty, the RIFLE criteria provide a uniform definition of AKI which has been validated in numerous studies.

More recently, Mehta et (1]., Crit. Care 11:R31 (doi:10.1186.cc5713), 2007, hereby incorporated by reference in its entirety, proposes the following similar classifications for stratifying AKI patients, which have been modified from RIFLE: “Stage I”: increase in serum nine of more than or equal to 0.3 mg/dL (2 26.4 umol/L) or increase to more than or equal to 150% (1.5-fold) from baseline OR urine output less than 0.5 mL/kg per hour for more than 6 hours; “Stage II”: increase in serum creatinine to more than 200% (> 2-fold) from baseline OR urine output less than 0.5 mL/kg per hour for more than 12 hours; “Stage III”: increase in serum creatinine to more than 300% (> 3-fold) from baseline OR serum creatinine 2 354 umol/L accompanied by an acute increase of at least 44 umol/L OR urine output less than 0.3 mL/kg per hour for 24 hours or anuria for 12 hours.

The CIN Consensus Working Panel (McCollough et al, Rev Cardiovasc Med. 2006; 7(4)3] 77-197, hereby incorporated by reference in its entirety) uses a serum creatinine rise of 25% to define Contrast induced nephropathy (which is a type of AKI).

Although various groups propose slightly different criteria for using serum creatinine to detect AKI, the consensus is that small changes in serum creatinine, such as 0.3 mg/dL or %, are sufficient to detect AKI ning renal function) and that the magnitude of the serum creatinine change is an tor of the severity of the AKI and mortality risk.

Although serial measurement of serum creatinine over a period of days is an accepted method of detecting and diagnosing AKI and is considered one of the most important tools to evaluate AKI patients, serum creatinine is generally regarded to have several tions in the diagnosis, assessment and monitoring of AKI patients. The time period for serum creatinine to rise to values (e.g., a 0.3 mg/dL or 25% rise) considered diagnostic for AKI can be 48 hours or longer depending on the definition used. Since ar injury in AKI can occur over a period of hours, serum creatinine elevations detected at 48 hours or longer can be a late indicator of injury, and relying on serum nine can thus delay diagnosis of AKI. rmore, serum creatinine is not a good indicator of the exact kidney status and ent needs during the most acute phases of AKI when kidney function is changing rapidly. Some patients with AKI will recover fully, some will need dialysis (either short term or long term) and some will have other detrimental outcomes including death, major adverse cardiac events and chronic kidney disease. Because serum creatinine is a marker of filtration rate, it does not differentiate between the causes of AKI (pre-renal, intrinsic renal, post-renal obstruction, atheroembolic, etc) or the ry or location of injury in sic renal disease (for example, tubular, glomerular or interstitial in origin). Urine output is similarly limited, Knowing these things can be of vital importance in managing and treating patients with AKI.

These tions underscore the need for better s to detect and assess AKI, particularly in the early and subclinical stages, but also in later stages when recovery and repair of the kidney can occur. Furthermore, there is a need to better identify patients who are at risk of having an AKI.

BRIEF SUMMARY OF THE INVENTION In an aspect, the invention provides methods and compositions for evaluating renal function in a subject. As described herein, measurement of one or more biomarkers selected from the group consisting of Heat shock 70 kDa protein 1, Alphaantitrypsin Neutrophil elastase complex, Stromelysin-1:Metalloproteinase inhibitor 2 complex, 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 or, Myeloid differentiation primary response protein MyD88, Neuronal cell adhesion molecule, and Tumor necrosis factor ligand superfamily member 10 (each referred to herein as a “kidney injury marker”) can be used for diagnosis, sis, risk fication, staging, monitoring, categorizing and determination of r diagnosis and treatment ns in subjects suffering or at risk of suffering from an injury to renal function, reduced renal function, and/or acute renal failure (also called acute kidney injury).

The kidney injury markers of the present invention may be used, individually or in panels comprising a plurality of kidney injury s, for risk stratification (that is, to identify subjects at risk for a future injury to renal function, for future progression to reduced renal function, for future progression to ARF, for future improvement in renal on, etc.); for diagnosis of existing disease (that is, to identify subjects who have suffered an injury to renal function, who have progressed to reduced renal function, who have progressed to ARF, etc.); for monitoring for deterioration or improvement of renal function; and for predicting a future medical outcome, such as improved or worsening renal function, a decreased or increased mortality risk, a decreased or increased risk that a subject will require renal ement therapy (i.e., hemodialysis, peritoneal dialysis, hemofiltration, and/or renal transplantation, a decreased or increased risk that a subject will recover from an injury to renal function, a decreased or increased risk that a subject will recover from ARF, a decreased or increased risk that a subject will progress to end stage renal disease, a decreased or increased risk that a subject will progress to chronic renal failure, a decreased or sed risk that a subject will suffer rejection of a lanted kidney, etc.

In an , the present invention relates to methods for ting renal status in a subject. These methods comprise performing an assay method that is configured to detect one or more biomarkers selected from the group consisting of Heat shock 70 kDa protein 1, Alphaantitrypsin Neutrophil se complex, Stromelysin- 1:Metalloproteinase inhibitor 2 complex, 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 or, Myeloid differentiation primary response protein MyD88, Neuronal cell on molecule, and Tumor necrosis factor ligand superfamily member 10 is/are then correlated to the renal status of the subject. This correlation to renal status may include correlating the assay result(s) to one or more of risk stratification, diagnosis, prognosis, staging, classifying and monitoring of the subject as described herein. Thus, the present invention utilizes one or more kidney injury markers of the present invention for the evaluation of renal injury. [0015A] In an aspect, the t ion provides a method for evaluating renal status in a t ex vivo, comprising: performing one or more assays configured to detect one or more biomarkers in a body fluid sample obtained previously from the subject to provide an assay result, wherein at least one of the markers is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex; and correlating an assay result(s) to the renal status of the subject.

In certain embodiments, the methods for evaluating renal status described herein are methods for risk stratification of the subject; that is, assigning a likelihood of one or more future changes in renal status to the subject. In these embodiments, the assay result(s) is/are correlated to one or more such future changes. The following are preferred risk stratification embodiments.

In red risk stratification embodiments, these methods comprise determining a subject’s risk for a future injury to renal function, and the assay result(s) is/are correlated to a likelihood of such a future injury to renal function. For example, the measured concentration(s) may each be compared to a threshold value. For a “positive going” kidney injury marker, an increased likelihood of suffering a future injury to renal function is assigned to the t when the measured concentration is above the threshold, relative to a likelihood assigned when the measured concentration is below the old. For a “negative going” kidney injury marker, an sed likelihood of suffering a future injury to renal function is assigned to the subject when the measured concentration is below the threshold, relative to a likelihood ed when the measured concentration is above the threshold.

In other preferred risk stratification embodiments, these s comprise ining a t’s risk for future reduced renal function, and the assay result(s) is/are correlated to a likelihood of such d renal function. For example, the measured concentrations may each be compared to a old value. For a “positive going” kidney injury marker, an increased likelihood of suffering a future reduced renal function is assigned to the subject when the measured concentration is above the threshold, relative to a likelihood assigned when the measured concentration is below the threshold. For a “negative going” kidney injury marker, an increased hood of future reduced renal function is assigned to the subject when the measured concentration is below the threshold, ve to a likelihood assigned when the measured concentration is above the threshold.

In still other preferred risk stratification embodiments, these s se determining a t’s likelihood for a future improvement in renal function, and the assay result(s) is/are correlated to a likelihood of such a future improvement in renal function. For example, the measured concentration(s) may each be compared to a threshold value. For a “positive going” kidney injury marker, an sed likelihood of a future improvement in renal function is assigned to the subject when the measured concentration is below the threshold, relative to a likelihood assigned when the measured concentration is above the threshold. For a “negative going” kidney injury marker, an increased likelihood of a future improvement in renal function is assigned to the subject when the measured concentration is above the threshold, relative to a likelihood assigned when the measured concentration is below the threshold.

In yet other preferred risk stratification embodiments, these methods comprise determining a subject’s risk for progression to ARF, and the result(s) is/are correlated to a likelihood of such progression to ARF. For example, the measured tration(s) may each be compared to a threshold value. For a “positive going” kidney injury marker, an sed likelihood of progression to ARF is assigned to the subject when the measured concentration is above the threshold, relative to a likelihood assigned when the measured tration is below the threshold. For a “negative going” kidney injury marker, an increased likelihood of progression to ARF is assigned to the subject when the measured concentration is below the threshold, relative to a likelihood ed when the measured tration is above the threshold.

And in other preferred risk stratification embodiments, these methods comprise determining a subject’s outcome risk, and the assay result(s) is/are ated to a hood of the occurrence of a clinical outcome related to a renal injury suffered by the subject. For example, the measured concentration(s) may each be compared to a threshold value. For a “positive going” kidney injury , an increased likelihood of one or more of: acute kidney injury, progression to a worsening stage of AKI, mortality, a requirement for renal replacement therapy, a requirement for withdrawal of renal toxins, end stage renal disease, heart failure, stroke, myocardial infarction, progression to chronic kidney disease, etc., is assigned to the t when the measured concentration is above the threshold, relative to a hood ed when the measured concentration is below the threshold. For a “negative going” kidney injury marker, an increased likelihood of one or more of: acute kidney injury, progression to a worsening stage of AKI, mortality, a requirement for renal replacement therapy, a requirement for withdrawal of renal toxins, end stage renal disease, heart failure, stroke, myocardial infarction, progression to chronic kidney disease, etc., is assigned to the subject when the measured concentration is below the threshold, relative to a likelihood assigned when the measured concentration is above the threshold.

In such risk stratification embodiments, preferably the likelihood or risk assigned is that an event of interest is more or less likely to occur within 180 days of the time at which the body fluid sample is obtained from the subject. In particularly preferred embodiments, the likelihood or risk assigned relates to an event of interest occurring within a shorter time period such as 18 months, 120 days, 90 days, 60 days, 45 days, 30 days, 21 days, 14 days, 7 days, 5 days, 96 hours, 72 hours, 48 hours, 36 hours, 24 hours, 12 hours, or less. A risk at 0 hours of the time at which the body fluid sample is obtained from the subject is equivalent to diagnosis of a current condition.

In preferred risk stratification embodiments, the subject is selected for risk stratification based on the pre-existence in the subject of one or more known risk factors for prerenal, intrinsic renal, or postrenal ARF. For e, a subject undergoing or having undergone major vascular surgery, coronary artery bypass, or other c surgery; a subject having pre-existing tive heart failure, preeclampsia, eclampsia, diabetes mellitus, hypertension, coronary artery disease, proteinuria, renal insufficiency, glomerular filtration below the normal range, cirrhosis, serum creatinine above the normal range, or sepsis; or a subject exposed to NSAIDs, cyclosporines, tacrolimus, lycosides, foscarnet, ethylene , hemoglobin, bin, ifosfamide, heavy metals, rexate, aque contrast agents, or streptozotocin are all preferred subjects for ring risks according to the s described herein. This list is not meant to be limiting. By “pre-existence” in this context is meant that the risk factor exists at the time the body fluid sample is obtained from the subject. In particularly preferred embodiments, a subject is chosen for risk fication based on an existing diagnosis of injury to renal on, reduced renal function, or ARF.

In other embodiments, the methods for evaluating renal status bed herein are methods for diagnosing a renal injury in the subject; that is, assessing whether or not a subject has suffered from an injury to renal function, d renal function, or ARF. In these embodiments, the assay result(s), for example measured concentration(s) of one or more biomarkers selected from the group ting of Heat shock 70 kDa protein 1, Alpha-l-antitrypsin Neutrophil elastase complex, Stromelysin-l:Metalloproteinase inhibitor 2 complex, 72 kDa type IV enase:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 receptor, Myeloid differentiation primary response protein MyD88, Neuronal cell adhesion molecule, and Tumor necrosis factor ligand superfamily member 10 is/are correlated to the occurrence or nonoccurrence of a change in renal . The following are preferred diagnostic embodiments.

In preferred diagnostic embodiments, these methods se diagnosing the occurrence or nonoccurrence of an injury to renal function, and the assay result(s) is/are correlated to the ence or nonoccurrence of such an injury. For example, each of the measured concentration(s) may be compared to a threshold value. For a positive going , an increased likelihood of the occurrence of an injury to renal function is assigned to the subject when the measured concentration is above the threshold (relative to the likelihood assigned when the measured concentration is below the threshold); alternatively, when the measured concentration is below the threshold, an increased likelihood of the nonoccurrence of an injury to renal function may be assigned to the subject (relative to the likelihood ed when the measured concentration is above the threshold). For a negative going marker, an increased likelihood of the occurrence of an injury to renal function is assigned to the subject when the measured concentration is below the old (relative to the likelihood assigned when the measured concentration is above the threshold); atively, when the measured concentration is above the threshold, an increased likelihood of the nonoccurrence of an injury to renal function may be assigned to the subject (relative to the likelihood assigned when the measured tration is below the old).

In other preferred diagnostic embodiments, these methods comprise diagnosing the occurrence or nonoccurrence of reduced renal function, and the assay result(s) is/are correlated to the ence or nonoccurrence of an injury causing reduced renal function. For example, each of the measured tration(s) may be compared to a threshold value. For a positive going marker, an sed likelihood of the occurrence of an injury causing reduced renal function is assigned to the t when the measured concentration is above the threshold (relative to the likelihood assigned when the ed concentration is below the threshold); alternatively, when the measured concentration is below the threshold, an increased hood of the nonoccurrence of an injury causing reduced renal function may be assigned to the t (relative to the likelihood ed when the measured concentration is above the threshold). For a negative going marker, an increased likelihood of the occurrence of an injury causing reduced renal function is assigned to the subject when the measured concentration is below the threshold (relative to the likelihood assigned when the measured concentration is above the threshold); alternatively, when the measured concentration is above the old, an increased likelihood of the nonoccurrence of an injury causing d renal function may be assigned to the subject (relative to the likelihood assigned when the measured concentration is below the threshold).

In yet other preferred diagnostic ments, these methods comprise diagnosing the occurrence or nonoccurrence of ARF, and the assay result(s) is/are correlated to the occurrence or nonoccurrence of an injury causing ARF. For example, each of the measured concentration(s) may be compared to a threshold value. For a positive going marker, an increased likelihood of the occurrence of ARF is ed to the subject when the measured concentration is above the threshold (relative to the likelihood assigned when the measured concentration is below the threshold); alternatively, when the measured concentration is below the threshold, an increased likelihood of the nonoccurrence of ARF may be assigned to the subject (relative to the likelihood assigned when the measured concentration is above the threshold). For a ve going marker, an increased likelihood of the occurrence of ARF is assigned to the t when the measured concentration is below the old (relative to the hood assigned when the measured concentration is above the threshold); alternatively, when the measured concentration is above the threshold, an increased likelihood of the nonoccurrence of ARF may be assigned to the subject (relative to the likelihood assigned when the measured concentration is below the threshold).

In still other preferred diagnostic embodiments, these s comprise diagnosing a subject as being in need of renal ement therapy, and the assay result(s) is/are correlated to a need for renal replacement therapy. For example, each of the ed concentration(s) may be compared to a threshold value. For a positive going marker, an increased likelihood of the occurrence of an injury creating a need for renal ement y is assigned to the subject when the measured tration is above the threshold (relative to the likelihood ed when the measured concentration is below the threshold); alternatively, when the measured concentration is below the threshold, an increased likelihood of the nonoccurrence of an injury creating a need for renal replacement therapy may be assigned to the subject (relative to the likelihood assigned when the measured tration is above the threshold). For a negative going marker, an increased likelihood of the occurrence of an injury creating a need for renal ement y is assigned to the subject when the measured concentration is below the threshold (relative to the likelihood assigned when the measured concentration is above the threshold); alternatively, when the measured concentration is above the threshold, an increased likelihood of the nonoccurrence of an injury creating a need for renal replacement therapy may be assigned to the subject (relative to the hood assigned when the measured concentration is below the threshold).

In still other red diagnostic embodiments, these methods comprise diagnosing a subject as being in need of renal transplantation, and the assay (s0 is/are correlated to a need for renal transplantation. For example, each of the measured concentration(s) may be compared to a threshold value. For a positive going marker, an increased likelihood of the occurrence of an injury creating a need for renal transplantation is assigned to the subject when the measured concentration is above the threshold (relative to the likelihood assigned when the measured concentration is below the threshold); alternatively, when the measured concentration is below the threshold, an increased hood of the nonoccurrence of an injury creating a need for renal transplantation may be assigned to the subject ive to the likelihood assigned when the measured concentration is above the threshold). For a negative going marker, an increased likelihood of the occurrence of an injury ng a need for renal transplantation is assigned to the subject when the measured concentration is below the threshold (relative to the likelihood assigned when the measured tration is above the threshold); alternatively, when the measured concentration is above the threshold, an increased likelihood of the nonoccurrence of an injury ng a need for renal transplantation may be ed to the subject (relative to the likelihood assigned when the measured concentration is below the threshold).

In still other ments, the methods for evaluating renal status described herein are s for monitoring a renal injury in the subject; that is, assessing whether or not renal function is improving or worsening in a subject who has suffered from an injury to renal function, reduced renal function, or ARF. In these embodiments, the assay (s), for example measured concentration(s) of one or more biomarkers ed from the group consisting of Heat shock 70 kDa protein 1, Alpha-l-antitrypsin Neutrophil 2012/052298 se complex, Stromelysin-l:Metalloproteinase inhibitor 2 complex, 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 receptor, Myeloid entiation primary response n MyD88, Neuronal cell adhesion molecule, and Tumor necrosis factor ligand superfamily member 10 receptor is/are correlated to the occurrence or nonoccurrence of a change in renal status. The following are preferred monitoring embodiments.

In preferred monitoring embodiments, these methods se monitoring renal status in a subject ing from an injury to renal function, and the assay result(s) is/are correlated to the occurrence or nonoccurrence of a change in renal status in the subject. For example, the measured tration(s) may be compared to a threshold value. For a positive going marker, when the measured concentration is above the threshold, a worsening of renal function may be assigned to the t; alternatively, when the measured concentration is below the threshold, an improvement of renal function may be assigned to the subject. For a negative going marker, when the measured concentration is below the threshold, a worsening of renal function may be assigned to the subject; alternatively, when the measured concentration is above the threshold, an improvement of renal function may be ed to the t.

In other preferred monitoring embodiments, these methods comprise monitoring renal status in a subject suffering from reduced renal on, and the assay result(s) is/are correlated to the occurrence or nonoccurrence of a change in renal status in the subject. For example, the measured concentration(s) may be compared to a threshold value. For a ve going marker, when the measured concentration is above the threshold, a worsening of renal function may be assigned to the subject; alternatively, when the measured tration is below the threshold, an improvement of renal on may be assigned to the subject. For a negative going marker, when the ed concentration is below the threshold, a worsening of renal function may be assigned to the subject; alternatively, when the measured concentration is above the threshold, an improvement of renal function may be assigned to the subject.

In yet other preferred monitoring embodiments, these methods comprise monitoring renal status in a subject suffering from acute renal failure, and the assay result(s) is/are correlated to the occurrence or nonoccurrence of a change in renal status in the subject. For example, the measured concentration(s) may be compared to a threshold value. For a ve going marker, when the measured concentration is above the threshold, a worsening of renal function may be assigned to the subject; alternatively, when the measured concentration is below the threshold, an improvement of renal function may be assigned to the subject. For a negative going marker, when the measured concentration is below the threshold, a ing of renal function may be assigned to the subject; alternatively, when the measured concentration is above the threshold, an improvement of renal function may be assigned to the subject.

In other additional preferred monitoring embodiments, these methods comprise monitoring renal status in a t at risk of an injury to renal function due to the pre-existence of one or more known risk factors for prerenal, intrinsic renal, or postrenal ARF, and the assay result(s) is/are correlated to the occurrence or nonoccurrence of a change in renal status in the subject. For example, the measured concentration(s) may be compared to a threshold value. For a ve going marker, when the measured concentration is above the threshold, a worsening of renal function may be assigned to the subject; atively, when the measured concentration is below the threshold, an improvement of renal on may be assigned to the subject. For a negative going marker, when the measured tration is below the threshold, a worsening of renal function may be assigned to the subject; alternatively, when the measured concentration is above the threshold, an improvement of renal function may be assigned to the subject.

In still other embodiments, the methods for evaluating renal status described herein are methods for classifying a renal injury in the subject; that is, determining whether a renal injury in a subject is prerenal, intrinsic renal, or postrenal; and/or further subdividing these classes into subclasses such as acute tubular injury, acute glomerulonephritis acute tubulointerstitial nephritis, acute vascular nephropathy, or infiltrative e; and/or assigning a likelihood that a subject will progress to a particular RIFLE stage. In these embodiments, the assay result(s), for example measured concentration(s) of one or more biomarkers ed from the group consisting of Heat shock 70 kDa protein 1, l-antitrypsin phil elastase complex, Stromelysin- l:Metalloproteinase tor 2 complex, 72 kDa type IV enase:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 receptor, Myeloid differentiation primary response protein MyD88, al cell adhesion le, and Tumor necrosis factor ligand superfamily member 10 is/are correlated to a particular class and/or subclass. The following are preferred classification embodiments.

In preferred fication ments, these methods comprise determining whether a renal injury in a subject is prerenal, intrinsic renal, or postrenal; and/or further subdividing these classes into subclasses such as acute tubular , acute glomerulonephritis acute tubulointerstitial nephritis, acute vascular nephropathy, or infiltrative disease; and/or assigning a likelihood that a subject will progress to a particular RIFLE stage, and the assay result(s) is/are correlated to the injury classification for the t. For e, the measured concentration may be compared to a threshold value, and when the measured concentration is above the threshold, a particular classification is assigned; alternatively, when the measured concentration is below the old, a different classification may be assigned to the t.

A variety of methods may be used by the skilled artisan to arrive at a desired threshold value for use in these methods. For example, the threshold value may be determined from a population of normal subjects by selecting a concentration representing the 75th, 85th, 90th, 95th, or 99th percentile of a kidney injury marker measured in such normal subjects. Alternatively, the threshold value may be determined from a “diseased” population of subjects, e. g., those suffering from an injury or having a predisposition for an injury (e.g., progression to ARF or some other clinical outcome such as death, dialysis, renal transplantation, etc.), by selecting a tration representing the 75th, 85th, 90th, 95th, or 99th percentile of a kidney injury marker measured in such subjects. In another alternative, the threshold value may be determined from a prior measurement of a kidney injury marker in the same subject; that is, a temporal change in the level of a kidney injury marker in the subject may be used to assign risk to the t.

The ing discussion is not meant to imply, however, that the kidney injury markers of the present invention must be compared to ponding individual olds. Methods for combining assay results can comprise the use of multivariate logistical regression, loglinear modeling, neural network analysis, n-of-m analysis, decision tree analysis, calculating ratios of markers, etc. This list is not meant to be ng. In these methods, a composite result which is determined by combining individual markers may be treated as if it is itself a marker; that is, a threshold may be determined for the composite result as described herein for individual markers, and the composite result for an individual patient ed to this old.

The ability of a particular test to distinguish two populations can be established using ROC analysis. For example, ROC curves established from a “first” subpopulation which is predisposed to one or more future changes in renal status, and a “second” subpopulation which is not so predisposed can be used to ate a ROC curve, and the area under the curve provides a measure of the quality of the test.

Preferably, the tests bed herein provide a ROC curve area greater than 0.5, preferably at least 0.6, more ably 0.7, still more preferably at least 0.8, even more preferably at least 0.9, and most preferably at least 0.95.

In certain aspects, the measured concentration of one or more kidney injury markers, or a composite of such markers, may be treated as continuous variables. For e, any particular concentration can be converted into a corresponding probability of a future reduction in renal on for the subject, the occurrence of an injury, a classification, etc. In yet another alternative, a old that can provide an acceptable level of specificity and sensitivity in separating a population of subjects into “bins” such as a “first” subpopulation (e. g., which is predisposed to one or more future changes in renal status, the occurrence of an injury, a classification, etc.) and a “second” subpopulation which is not so predisposed. A threshold value is ed to separate this first and second population by one or more of the following measures of test accuracy: an odds ratio r than 1, preferably at least about 2 or more or about 0.5 or less, more preferably at least about 3 or more or about 0.33 or less, still more ably at least about 4 or more or about 0.25 or less, even more preferably at least about 5 or more or about 0.2 or less, and most preferably at least about 10 or more or about 0.1 or less; a specificity of greater than 0.5, preferably at least about 0.6, more ably at least about 0.7, still more preferably at least about 0.8, even more preferably at least about 0.9 and most preferably at least about 0.95, with a corresponding sensitivity greater than 0.2, ably greater than about 0.3, more ably greater than about 0.4, still more preferably at least about 0.5, even more preferably about 0.6, yet more preferably greater than about 0.7, still more preferably greater than about 0.8, more preferably greater than about 0.9, and most preferably greater than about 0.95; a sensitivity of greater than 0.5, preferably at least about 0.6, more preferably at least about 0.7, still more preferably at least about 0.8, even more preferably at least about 0.9 and most preferably at least about 0.95, with a corresponding specificity greater than 0.2, preferably greater than about 0.3, more preferably greater than about 0.4, still more preferably at least about 0.5, even more preferably about 0.6, yet more preferably greater than about 0.7, still more preferably greater than about 0.8, more preferably greater than about 0.9, and most preferably greater than about 0.95; at least about 75% ivity, combined with at least about 75% specificity; a positive likelihood ratio (calculated as sensitivity/(l-specificity)) of greater than 1, at least about 2, more preferably at least about 3, still more preferably at least about 5, and most preferably at least about 10; or a negative likelihood ratio (calculated as (l-sensitivity)/specificity) of less than 1, less than or equal to about 0.5, more preferably less than or equal to about 0.3, and most preferably less than or equal to about 0.1.

The term “about” in the context of any of the above measurements refers to +/- 5% of a given measurement.

Multiple thresholds may also be used to assess renal status in a subject. For example, a “first” subpopulation which is predisposed to one or more future changes in renal status, the occurrence of an injury, a classification, etc., and a “second” subpopulation which is not so predisposed can be ed into a single group. This group is then ided into three or more equal parts (known as tertiles, quartiles, quintiles, etc., depending on the number of subdivisions). An odds ratio is ed to subjects based on which subdivision they fall into. If one considers a tertile, the lowest or highest tertile can be used as a nce for comparison of the other subdivisions. This reference subdivision is assigned an odds ratio of l. The second tertile is assigned an odds ratio that is relative to that first tertile. That is, someone in the second e might be 3 times more likely to suffer one or more future changes in renal status in ison to someone in the first tertile. The third tertile is also assigned an odds ratio that is relative to that first tertile.

In certain embodiments, the assay method is an assay. Antibodies for use in such assays will specifically bind a full length kidney injury marker of interest, and may also bind one or more polypeptides that are “related” thereto, as that term is defined after. Numerous immunoassay formats are known to those of skill in the art.

Preferred body fluid samples are selected from the group consisting of urine, blood, serum, saliva, tears, and plasma. In the case of those kidney injury markers which are membrane proteins as bed hereinafter, preferred assays detect soluble forms thereof.

The foregoing method steps should not be reted to mean that the kidney injury marker assay result(s) is/are used in isolation in the methods described herein.

Rather, additional variables or other clinical indicia may be included in the methods described herein. For example, a risk stratification, diagnostic, classification, ring, etc. method may combine the assay result(s) with one or more variables measured for the subject selected from the group consisting of demographic information (e. g., , sex, age, race), medical history (e. g., family history, type of y, pre-existing disease such as aneurism, congestive heart failure, preeclampsia, eclampsia, diabetes mellitus, hypertension, coronary artery disease, proteinuria, renal iciency, or sepsis, type of toxin re such as NSAIDs, cyclosporines, tacrolimus, aminoglycosides, foscamet, ethylene glycol, hemoglobin, myoglobin, ifosfamide, heavy metals, rexate, radiopaque contrast agents, or streptozotocin), clinical variables (e. g., blood pressure, temperature, respiration rate), risk scores (APACHE score, PREDICT score, TIMI Risk Score for UA/NSTEMI, Framingham Risk Score, risk scores of Thakar et al. (J. Am. Soc.

Nephrol. 16: 162-68, 2005), Mehran et al. (J. Am. Coll. Cardiol. 44: 1393-99, 2004), Wijeysundera et al. (JAMA 297: 1801-9, 2007), Goldstein and Chawla (Clin. J. Am. Soc.

Nephrol. 5: 943-49, 2010), or Chawla et al. (Kidney Intl. 68: 2274-80, 2005)), a glomerular filtration rate, an estimated glomerular filtration rate, a urine production rate, a serum or plasma creatinine concentration, a urine creatinine concentration, a fractional excretion of sodium, a urine sodium concentration, a urine creatinine to serum or plasma creatinine ratio, a urine specific gravity, a urine osmolality, a urine urea en to plasma urea en ratio, a plasma BUN to creatnine ratio, a renal failure index calculated as urine sodium / (urine creatinine / plasma creatinine), a serum or plasma phil gelatinase (NGAL) concentration, a urine NGAL concentration, a serum or plasma cystatin C concentration, a serum or plasma c troponin concentration, a serum or plasma BNP concentration, a serum or plasma NTproBNP concentration, and a serum or plasma proBNP concentration. Other measures of renal function which may be combined with one or more kidney injury marker assay result(s) are described after and in Harrison’s Principles of Internal Medicine, l7Lh Ed., McGraw Hill, New York, pages 1741-1830, and Current Medical Diagnosis & Treatment 2008, 47th Ed, McGraw Hill, New York, pages 785-815, each of which are hereby orated by reference in their entirety.

When more than one marker is measured, the individual markers may be measured in samples ed at the same time, or may be determined from samples obtained at different (e.g., an earlier or later) times. The dual markers may also be measured on the same or different body fluid s. For example, one kidney injury marker may be measured in a serum or plasma sample and another kidney injury marker may be measured in a urine sample. In addition, assignment of a likelihood may combine an individual kidney injury marker assay result with temporal changes in one or more additional variables.

In various related aspects, the present invention also relates to devices and kits for performing the s described herein. Suitable kits comprise reagents sufficient for performing an assay for at least one of the described kidney injury markers, together with instructions for performing the described threshold comparisons.

In certain embodiments, reagents for performing such assays are provided in an assay device, and such assay devices may be included in such a kit. red reagents can comprise one or more solid phase antibodies, the solid phase antibody comprising antibody that detects the intended biomarker (s) bound to a solid support. In the case of ch immunoassays, such reagents can also include one or more detectably labeled antibodies, the ably labeled dy comprising antibody that detects the ed ker target(s) bound to a detectable label. Additional optional ts that may be provided as part of an assay device are described hereinafter. [0046A] In an , the present invention provides a kit comprising reagents when used to evaluate renal status ex vivo by performing one or more assays on a body fluid sample obtained previously from a subject configured to detect 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex.

Detectable labels may include molecules that are themselves detectable (e.g., fluorescent moieties, electrochemical labels, ecl (electrochemical luminescence) labels, metal chelates, colloidal metal particles, etc.) as well as molecules that may be indirectly detected by production of a detectable reaction product (e.g., enzymes such as horseradish peroxidase, alkaline atase, etc.) or through the use of a specific binding molecule which itself may be able (e.g., a labeled antibody that binds to the second antibody, biotin, digoxigenin, maltose, oligohistidine, 2,4-dintrobenzene, phenylarsenate, ssDNA, dsDNA, etc.). tion of a signal from the signal development element can be performed using various optical, acoustical, and electrochemical methods well known in the art.

Examples of detection modes include fluorescence, radiochemical ion, tance, absorbance, amperometry, conductance, impedance, interferometry, ellipsometry, etc. In certain of these methods, the solid phase antibody is coupled to a transducer (e.g., a diffraction grating, electrochemical sensor, etc) for generation of a signal, while in others, a signal is generated by a transducer that is spatially separate from the solid phase antibody (e.g., a fluorometer that employs an excitation light source and an l or). This list is not meant to be ng. Antibody-based biosensors may also be employed to determine the presence or amount of analytes that optionally eliminate the need for a labeled le. [0048A] In an aspect, the present invention provides a method for evaluating biomarker levels in a body fluid , sing: a urine sample obtained previously from a subject selected for evaluation based on a determination that the subject is at risk of a future or current acute renal injury; and performing a plurality of analyte binding assays configured to detect one or more biomarkers, wherein at least one biomarker is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex by introducing the urine sample obtained previously from the subject into an assay instrument which (i) contacts a plurality of ts which specifically bind for detection of one or more biomarkers within the urine sample, wherein at least one biomarker ed is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex and (ii) generates one or more assay results indicative of binding of the one or more kers assayed to a respective specific binding reagent in the plurality of reagents. [0048B] In an aspect, the present invention provides a system when used to evaluate renal status ex vivo, comprising: a t(s) which specifically bind for detection of one or more biomarkers, wherein at least one ker is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex; an assay instrument configured to receive a urine sample and contact the reagent(s) with the urine sample and to generate one or more assay results indicative of binding of the one or more biomarkers assayed to a respective specific binding reagent in the reagent(s).

DETAILED DESCRIPTION OF THE INVENTION The present ion relates to s and compositions for diagnosis, differential diagnosis, risk fication, monitoring, classifying and determination of treatment regimens in subjects suffering or at risk of suffering from injury to renal function, reduced renal function and/or acute renal failure through measurement of one or more kidney injury markers. In various embodiments, a measured concentration of one or more biomarkers selected from the group consisting of Heat shock 70 kDa protein 1, Alphaantitrypsin Neutrophil elastase complex, Stromelysin-1:Metalloproteinase inhibitor 2 complex, 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 receptor, Myeloid differentiation primary response protein MyD88, Neuronal cell adhesion le, and Tumor necrosis factor ligand superfamily member 10 or one or more markers related thereto, are correlated to the renal status of the subject.

For purposes of this document, the following definitions apply: As used herein, an “injury to renal function” is an abrupt (within 14 days, preferably within 7 days, more preferably within 72 hours, and still more preferably within 48 hours) measurable ion in a e of renal function. Such an injury may be identified, for example, by a decrease in glomerular filtration rate or estimated GFR, a reduction in urine output, an se in serum creatinine, an se in serum cystatin C, a requirement for renal replacement therapy, etc. “Improvement in Renal on” is an abrupt (within 14 days, preferably within 7 days, more preferably within 72 hours, and still more ably within 48 hours) measurable increase in a measure of renal function.

Preferred methods for measuring and/or estimating GFR are bed hereinafter.

As used herein, “reduced renal function” is an abrupt (within 14 days, preferably within 7 days, more preferably within 72 hours, and still more preferably within 48 hours) reduction in kidney function identified by an absolute increase in serum nine of greater than or equal to 0.1 mg/dL (2 8.8 umol/L), a percentage increase in serum nine of greater than or equal to 20% (l .2-fold from baseline), or a reduction in urine output (documented oliguria of less than 0. 5 ml/kg per hour).

As used herein, “acute renal failure” or “ARF” is an abrupt (within 14 days, preferably within 7 days, more preferably within 72 hours, and still more preferably within 48 hours) reduction in kidney function identified by an absolute increase in serum creatinine of greater than or equal to 0.3 mg/dl (2 26.4 umol/l), a percentage increase in serum creatinine of greater than or equal to 50% (l. 5-fold from baseline), or a reduction in urine output (documented ia of less than 0.5 ml/kg per hour for at least 6 hours).

This term is synonymous with “acute kidney injury” or “AKI.” As used herein, the term “Heat shock 70 kDa protein 1” refers to one or more polypeptides present in a biological sample that are derived from the Heat shock 70 kDa protein 1 precursor (human precursor Swiss-Prot P08107 (SEQ ID NO: 1)). 20 3O 4O 50 6O MAKAAAIGID LGTTYSCVGV EIIA NDQGNRTTPS YVAFTDT?R. IGDAAKVQVA 7O 8O 9O "00 110 120 LNPQNTVFDA KFGD PVVQSD KHW PFQVINDGDK PKVQVSY<GL iKAhYPfifiIS 130 140 150 "60 170 180 SMVLLK KfiI AflAYLGYPVT NAVITVPAYF NDSQRQATKD AGVIAGIVV. RIIN?PTAAA 190 200 210 220 230 240 IAYGLDRTGK GERNVLIFDL GGGTFDVSIL lIDDGIbLVK AiAGDiiuGG fiDbDVRLVWH 250 260 270 280 290 300 QKHK KDISQNKRAV QQLRLACLRA KQLASSSLQA SuflIDSIEflG iRA 310 320 330 340 350 360 RbflflLCSDLb RSiLflPVfiKA .RDAK.D<AQ IiDnVLVGGS QKAL QDFFWGRDAN 370 380 390 ~00 ~10 ~20 KSIVPDEAVA YGAAVQAAIL MGD<S?WVQD L...DVAPLS .GL?TAGGVM NSTI ~30 440 450 ~60 ~70 ~80 PT<QTQIFTT YSDNQPGVLI QVYflGfiRAMi KDVVLIGRF? .SGIPPAPRG VPQIEVTFDI ~90 500 510 520 530 540 DAWGILNVTA TDKSTGKANK ITITND<GRL S<flfiIfiRMVQ fiAfiKYKAfiDfi VQRflRVSAKV 550 560 570 580 590 600 ALESYAFNMK GLKG KISEAD<KKV LD<CQ?VISW .DANLLAflK U _1. IT fl ._L. {RKfiLfl 610 620 630 640 QVCNPIISGL PGPG GFGAQGPKGG SGSGPiIflfiV D The following domains have been fied in Heat shock 70 kDa protein 1: Residues Length Domain ID 1 1 Initiator methionine 2-641 640 Heat shock 70 kDa protein 1 As used herein, the term “Stromelysin-l :Metalloproteinase inhibitor 2 complex” refers to a polypeptide complex present in a biological sample that comprises one or more polypeptides that are derived from the Stromelysin-l precursor and one or more polypeptides that are derived from the Metalloproteinase inhibitor 2 precursor. used herein, the term “72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex” refers to a polypeptide complex present in a biological sample that comprises one or more polypeptides that are d from the 72 kDa type IV collagenase precursor and one or more polypeptides that are derived from the Metalloproteinase inhibitor 2 precursor.

The human Stromelysin-l precursor has the following ce (Swiss-Prot P08254 (SEQ ID NO: 2)): 1g 2g 3g -0 5g 6g MKSLPILLLL CVAVCSAYPL DGAARGEDTS NLVQ<YLEN YYDLKKDVKQ FVRRKDSGPV 7g 8g 9g 100 11g 12g VKKIRflMQKt LGLflVIGKLD SDTL?V RKP RCGVPDVGiF PKWR KTHATYRIVN 13g 14g "50 160 17g 18g YTPDAPKDAV DSAV?KALKV WflflVIPL_bS RIYflGflADIM ISFAVREHGD FYPFDGPGNV 19g 20g 210 22 23g 24g PGPG EDDD LQWIKDI_GI VIEIVAA{* GHSLGIFHSA YPLY 25g 26g 27g 28g 29g 30g HSATDLTRFR LSQDDINGIQ SAYGPPPDSP flIPIVPIflPV PPflPGIPANC DPALSFDAVS 31g 32g 33g 34g 35g 36g TLRG?IIIFK DRHFWRKSIR KuflPfluHLIS SFWPSAPSGV DAAYEVTSKD LVFIFKGNQF 37g 380 39g -00 -1g 42g WAIRGNEVRA GYPRGIHTAG FPPTVRKIDA AISDKL<RKI thVLDKYWR bDfiKRNSMfiP 43g 44g 45g -6g -7g GFPKQIAEDF PGIDSKIDAV bflflbibeb iGSSQIflbDP NAKKVTHTLK SNSWANC [005 9] The following domains have been identified in Stromelysin-l: Residues Length Domain ID 1- l 7 17 signal sequence 18-99 82 propeptide 100-477 378 Stromelysin-l The human 72 kDa type IV collagenase precursor (Swiss-Prot P08253 (SEQ ID NO: 3)) has the following sequence: 20 3O 4O 50 6O M?ALMARGAI TGPIRALCLL GCILSHAAAA PSPIIKFPGD VAPKTDKELA VQYLNTFYGC 7O 8O 90 100 110 120 P<?SCN.FV. KDTI<KMQKF FGDPQTGDLD QNTIETMRKP RCGNPDVANY NFFPRKPKWD 130 140 150 160 170 180 KWQITYRIIG Pfi_V DDAEARAEQV WSDVTPDRFS RIHDGEADIM INFGRWEHGD 190 200 210 220 230 240 GYPFDG<DGL LAHAFAPGTG VGGDSibDDD flLWILGflGQV VRVKYGWADG EYCKFPFLFN 250 260 270 280 290 300 GKEYNSCTDT GRSDGFLWCS TTYVFEKDGK YGbCPHLALb IMGGVALGQP CKFPFRFQGT 310 320 330 340 350 360 SYDSCTTEG? CGTT EDYDRDKKYG FCPETA STV GGNSEGAPCV FPFTFDGRKY 370 380 390 ~00 ~10 ~20 ESCTSAGRSD G<MWCATTAN WGFC PDQGYSLFLV AAHEFGiAMG LEHSQDPGAL ~30 440 450 ~60 ~70 ~80 .APIYTYT<W FQLSQDDIKG IQ?.YGASPD PTPT EIC< QDIVFDGIAQ ~90 500 510 520 530 540 IRGEIFFF<D RFIWRTVTPR DLVA PflKI DAVYflAPQflfl GNLY 550 560 570 580 590 600 WIYSASTLER GYPKPLTSLG LPPDVQRVDA AFNWSKN<KT YIFAGDKFWR YNEVKKKMDP 610 620 630 640 650 660 GFPKLIADAW NAIPDNLDAV VDLQGGGHSY FFKGAYY.KL ?NQSLKSVKF GSIKSDWLGC The following domains have been identified in 72 kDa type IV collagenase: Residues Length Domain ID l-29 29 Signal peptide - 109 90 Activation peptide 0 551 72 kDa type IV collagenase (4-73) The human Metalloproteinase inhibitor 2 precursor (Swiss-Prot P16035 (SEQ ID NO: 4)) has the following sequence: 20 3O 4O 50 6O TIRL AIGLLLLATL LRPADACSCS PVHPQQAFCN ADVVIRAKAV SfiKfiVDSGND 7O 8O 90 100 110 120 IYGNPIKRIQ YEIKQIKMtK GPflKDIfibIY IAPSSAVCGV SLDVGGKK?Y .IAGKA?GDG 130 140 150 160 170 180 KMHITLCDFI VPWDTASTTQ KKSLNHRYQM GCECKITRCP MIPCYISSPD ECLWMDWVTE 190 200 210 220 KNINGHQAKF FACIKRSDGS CAWYRGAAPP KQfibLDIfiDP The ing domains have been identified in oproteinase inhibitor 2: es Length Domain ID l-26 26 Signal peptide 27-220 194 Metalloproteinase inhibitor 2 As used herein, the term “Insulin-like growth factor 1 receptor” refers to one or more polypeptides present in a biological sample that are derived from the Insulin-like growth factor 1 receptor precursor (Swiss-Prot P08069 (SEQ ID NO: 5)). 20 3O 4O 50 6O MKSGSGGGSP TSLWGLLFLS AALSLWPTSG EICGPGIDIR NDYQQLKRLL NCIVILGYLH 7O 8O 90 100 110 120 ILLISKAEDY RSYRFPKLTV ITEYLLLFRV AGLESLGDLF PNLTVIRGWK LFYNYALVIF 130 140 150 160 170 180 EMTNLKDIGL YNLRNITRGA ADLC WSLI LDAVSNNYIV GNKPPKECGD 190 200 210 220 230 240 LCPGlMfiflKP MCflKIIINNL YNYRCWTTNR STCG KRAClflNNflC CHPfiCLGSCS 250 260 270 280 290 300 APDNDTACVA CRHYYYAGVC VPACPPNTYR FEGWRCVDRD FCANILSAfiS SDSflGtVIHD 310 320 330 340 350 360 GfiCMQfiCPSG bIRNGSQSMY CIPCEGPCPK VCflflflKKIKI IDSVISAQML QGCTIFKGNL 2012/052298 370 380 390 400 410 420 LINIRRGNNI ASflLflNbMGL IfiVViGYVKI RHSHALVSLS FLKNLRLILG NYSb 430 440 450 460 470 480 YVLDNQNLQQ LWDWDHRNLT IKAGKMYFAF NPKLCVSfiIY RMfl fiViGiKG RQSKGDINTR 490 500 510 520 530 540 NNGflRASCfiS DVLHFTSTTT SKNRIIITWH RYRPPDYRDL ISbiVYYKLA LYDG 550 560 570 580 590 600 QDACGSNSWN MVDVDLPPNK DVEPGILLHG LKPWTQYAVY VKAVTLTMV L‘J AKSL‘J 610 620 630 640 650 660 ILYIRTNASV PSIPLDVLSA SNSSSQLIVK WNPPSLPNGN LSYYIVRWQR QPQDGYLYRH 670 680 690 700 710 720 NYCSKDKIPI RKYADGiIDI fiNPKifi VCGGfiKGPCC ACPKi «AaKQ .flAfiYRK 730 740 750 760 770 780 VFENFLHNSI FVPRPERKRR DVMQVANTTM iiAA DiYNliDP 1 1 .Lfli fiYPbt fiS 790 800 810 820 830 840 RVDNKERTVI SNLRPFTLYR IDIHSCNHfiA flKLGCSASNF VFARTMPAEG PVTW 850 860 870 880 900 fiPRPfiNSIbL KWPfiPfiNPNG LILMY?IKYG SQVfiDQRfiCV SRQEYRKYGG AKLNRLNPGN 910 920 930 940 950 960 YTARIQATSL SGNGSWTDPV FFYVQAKTGY ?NFIHLIIAL PVAVLLIVGG LVIMLYVFHR 970 980 990 1000 1010 1020 LGNG VLYASVNPEY FSAADVYVPD fiWfiVARfiKIi MSRLLGQGSE GMVYLGVAKG 1030 1040 1050 1060 1070 1080 VVKDflPfiiRV AIKTVN?AAS MRfiRIflbLNfi ASVMKEFNCH HVVRLLGVVS QGQPTLVIML‘J 1090 1100 1110 1120 1130 1140 LMTRGDLKSY LRSLRPfiMfiN NPVTAPPSLS KMIQMAGEIA DGMAYLNANK FVHRDLAARN 1150 1160 1170 1180 1190 1200 CMVAEDFTVK IGDFGMTRDI YETDYYRKGG KGLLPVRWMS PESLKDGVFT TYSDVWSFGV 1210 1220 1230 1240 1250 1260 VLWflIAlLAfl QPYQGLSNfiQ VLRtVMfiGGL LDKPDNCPDM LFELMRMCWQ YNPKMRPSFL 1270 1280 1290 1300 1310 1320 KflfiM flPGbRflVSbY YSflfiNKLPfiP fiflLDLflPflNM flSVPLDPSAS SSSLPLPDRH 1330 1340 1350 1360 SGHKAENGPG PGVLVLRASF AHMN GGRKNERALP LPQSSTC Most preferably, the n-like growth factor 1 receptor assay detects one or more soluble forms of Insulin-like growth factor 1 receptor. Insulin-like growth factor 1 or is a single-pass type I membrane protein having a large extracellular domain, most or all of which is present in soluble forms of Insulin-like growth factor 1 receptor generated either through alternative splicing event which s all or a portion of the transmembrane domain, or by proteolysis of the membrane-bound form. In the case of an immunoassay, one or more antibodies that bind to epitopes within this extracellular domain may be used to detect these e form(s). The following domains have been identified in Insulin-like growth factor 1 receptor: es Length Domain ID 1-30 30 signal sequence 31-736 706 Insulin-like growth factor 1 receptor alpha chain (extracellular) 741-1367 627 Insulin-like growth factor 1 receptor beta chain 741 -935 195 extracellular 936-959 24 embrane 960-1367 408 cytoplasmic As used herein, the term “myeloid differentiation primary response protein MyD88” refers to one or more polypeptides present in a biological sample that are derived from the myeloid differentiation primary response protein MyD88 precursor (Swiss-Prot Q99836 (SEQ ID NO: 6)). 20 30 40 50 60 MAAGGPGAGS AAPVSSTSSL PLAALNMRVR RRLSLFLNVR WIAL AflfiMDbfiYLfl 7O 80 9O 100 110 120 IRQLETQADP TGRLLDAWQG RPGASVGRLL ELLTKLGRDD VLLflLGPSI.J. fiDCQKYILKQ 130 140 150 160 170 180 .flAfiKPLQ VAAVDSSVPR TA?LAGITTL MP?R FDAFICYCPS DIQFVQEMIR 190 200 210 220 230 240 QLEQTNYRLK LCVSDRDVLP GTCVWSIAS.J. LIfiKRCRRMV VVVSDDYLQS KECDFQTKFA 250 260 270 280 290 LSLSPGAHQK RLIPIKYKAM KK LbPSILRb IiVCDYiNPC iKSWbWiRLA KALSLP As used herein, the term “neuronal cell adhesion molecule” refers to one or more polypeptides present in a biological sample that are derived from the neuronal cell adhesion molecule precursor (Swiss-Prot Q92823 (SEQ ID NO: 7)). 20 3O 40 50 6O MQLKIMPKKK RLSAGRVPLI LFLCQMISAL KLL7J. DLVQPPTITQ QSPKDYIIDP 7O 80 9O 100 110 120 RENIVIQCEA SFSW TRNGTHFDID KDPLVTMKPG NIMS fiGKAfiiYfiGV 130 140 150 160 170 180 YQCTARNERG AAVSNNIVVR PSRSPLWLK.J. KLflPIiLQSG QSLVLPCRPP IGLPPPIIFW 190 200 210 220 230 240 RLPQ GLNG DT.YJ: SNVTE> J. . DiRfiDYICYA RFNHTQTIQQ KQPISVKVIS 250 260 270 280 290 300 VDELNDTIAA NLSDTEFYGA KSSRLRPPlt LiPLGNASNK VLSL fiCIAflGLPiP 310 320 330 340 350 360 IIYWAKEDGM LPKNRTVYKN FEKTLQIIHV SEADSGNYQC IAKNALGAIH HTISVRVKAA 370 380 390 400 410 420 PYWITAPQNL VLSPGEDGTL ICRANGNPKP RISWLTNGVP IEIAPDDPSR IIFS 430 440 450 460 470 480 NVQERSSAVY QCNASNEYGY LLANAFVNVL AEPPRILTPA NTLYQVIANR PALLDCAFFG 490 500 510 520 530 540 SPLPTIEWFK GAKGSALHWDJ. IYVLHfiNGiL fiIPVAQKDST ARNK LGMAKNEVHL 550 560 570 580 590 600 EIKDPTWIVK QPEYAVVQRG SMVSFECKVK HDHTLSLTVL WLKDNRflLPS DuRbiVDKDH 610 620 630 640 650 660 LVVADVSDDD SGTYTCVANT TLDSVSASAV TPTP APVYDVPNPP FDLELTDQLD 670 680 690 700 710 720 KSVQLSWTPG DDNNSPIiKt IIfiYflDAMHK PGLWHHQTEV SGTQTTAQLK YSFR 730 740 750 760 770 780 VMAVNSIGKS LPSflASfiQYL 1KASfiPDKNP 1AVflGLGSflP DNLVITWKPL NGFESNGPGL 790 800 810 820 830 840 RQKD GDDEWTSVVV ANVSKYIVSG TPTFVPYLIK VQALNDMGFA MGHS 850 860 870 880 890 900 GEDLPMVAPG NVRVNVVNST LAEVHWDPVP LKSIRGHLQG YRIYYWKTQS SSKRNRRHIL‘J 910 920 930 940 950 960 KKILTFQGSK THGMLPGLEP FSHYTLNVRV VNGKGEGPAS TPEG VPSAPSSLKI 970 980 990 1000 1010 1020 VNPTLDSLTL EWDPPSHPNG ILTEYTLKYQ PINSTHELGP PANK TRWTLKNLNF 1030 1040 1050 1060 1070 1080 STRYKFYFYA QTSAGSGSQI 1flflAV11VDL AGILPPDVGA GKVQAVNTRI SNLTAAAAET 1090 1100 1110 1120 1130 1140 YANISWflYfiG PflHVNtYVLY GVAGSKflflWR KfiIVNGSRSF FGLKGLMPGT AYKVRVGAVG 1150 1160 1170 1180 1190 1200 DSGbVSSflDV bfiiGPAMASR QVDIATQGWF IGLMCAVALL ILILLIVCFI RRNKGGKYPV 1210 1220 1230 1240 1250 1260 HADP flIQPMKflDDG DAflD HKPLKKGSRT PSDRTVKKED SDDSLVDYGL‘J 1270 1280 1290 1300 NEDG SFIGQYSGKK flKfiPAflGNflS SfiAPSPVNAM NSFV Most preferably, the neuronal cell adhesion molecule assay detects one or more soluble forms of neuronal cell adhesion molecule. The Neuronal cell adhesion molecule precursor encodes a single-pass type I membrane protein having a large extracellular domain, most or all of which is present in soluble forms of neuronal cell on molecule generated either through alternative splicing event which deletes all or a portion of the transmembrane domain, or by proteolysis of the membrane-bound form.

In the case of an immunoassay, one or more antibodies that bind to epitopes within this extracellular domain may be used to detect these soluble form(s). The following domains have been identified in neuronal cell adhesion molecule: Residues Length Domain ID 1-24 24 signal ce - 1304 1280 al cell adhesion molecule -1 167 1 143 extracellular 1 168-1 190 23 transmembrane 1 19 1- 1304 114 cytoplasmic As used herein, the term “Tumor necrosis factor ligand superfamily member ” refers to one or more polypeptides present in a biological sample that are derived from the Tumor necrosis factor ligand superfamily member 10 precursor (Swiss-Prot P50591 (SEQ ID NO: 8)) 20 3O 4O 50 6O MAMMEVQGGP SLGQTCVLIV IFTVILquC VAVIYVYE_N LLKQ QDKYS KSGIACFLKE 7O 8O 90 100 110 120 DDSYWDPNDfi CWQV KWQIRQIVRK MILRISflfi_I SIVQLKQQNI SPIVR?RGPQ 130 140 150 160 170 180 RVAAHITGTR GRSVTLSSPN SKV?<A.GRK INSWESSRSG HSFLSNuHLR NGflLVIHfiKG 190 200 210 220 230 240 FYYIYSQIYE RbQfifiIKfiNI KND<QMVQYI PDPI LLMKSARNSC YGLY 250 260 270 280 SIYQGGIhflL KfiNDRIhVSV DMDH EASFFGAFLV G This protein is also known as TRAIL and APOZL. Most ably, the Tumor necrosis factor ligand superfamily member 10 precursor assay s one or more soluble forms of Tumor necrosis factor ligand superfamily member 10 precursor . The Tumor necrosis factor ligand superfamily member 10 precursor encodes a single-pass type II membrane protein having a large extracellular domain, most or all of which is present in e forms of Tumor necrosis factor ligand superfamily member 10 sor generated either through alternative ng event which deletes all or a portion of the transmembrane domain, or by lysis of the membrane-bound form. In the case of an immunoassay, one or more antibodies that bind to epitopes within this extracellular domain may be used to detect these e form(s). The following s have been identified in Tumor necrosis factor ligand superfamily member 10 precursor : Residues Length Domain ID 1-281 281 Tumor is factor ligand superfamily member 10 1-17 17 cytoplasmic domain 18-38 21 Signal-anchor for type 11 membrane n 39-281 243 extracellular domain As used herein, the term “alphaantitrypsin:leukocyte elastase complex” refers to a polypeptide complex present in a biological sample that comprises one or more polypeptides that are derived from the alphaantitrypsin precursor and one or more polypeptides that are derived from the leukocyte elastase precursor.

The human alphaantitrypsin precursor has the following sequence (Swiss- Prot P01009 (SEQ ID NO: 9)): 20 30 40 50 6O MPSSVSWGIL LLAGLCCLVP VSLAEDPQGD AAQKTDTSHH DQDHPTFNKI TPNLAEFAFS 70 80 9O 100 110 120 LYRQLAHQSN STNIFFSPVS IATAFAMLSL GiKADiHDfiI T.*.GT.NJ: NT.1*. IPfiAQIH fiGb 130 140 150 160 170 180 QELLRTLNQP DSQLQLTTGN GT.FT.S':'.GT.KT. VDKFL?DVKK LYHSflAbiVN bGDi fifiAKKQ 190 200 210 220 230 240 INDYVEKGTQ GKIVDLVKEL ALVN KW flR Pb flVKDiflflfl DbHVDQViiV 250 260 270 280 290 300 KVPMMKRLGM FNIQHCKKLS SWVLLMKYLG NATAIFFLPD ?GKLQHL flNfl LiHDIIiKhL 310 320 330 340 350 360 fiNfiDRRSASL HLPKLSITGT YDLKSVLGQL GITKVFSNGA DLSGVlfl flAP LKLSKAVHKA 370 380 390 400 410 VLIIDfiKGIfi AAGAMFL?AI PMSIPPLVKE NKPtVtLMIL QNIKSPLbMG KVVNPIQK The following domains have been identified in alpha-l-antitrypsin: Residues Length Domain ID 1-24 24 signal sequence -418 394 alphaantitrypsin The human leukocyte elastase precursor (Swiss-Prot P08246 (SEQ ID NO: )) has the following ce: 20 3O 4O 50 6O MTLGRRLACL FLACVLPALL LGGTALAS?I VGGRRARPHA WPFMVSLQLR GGHFCGATLI 7O 8O 90 100 110 120 APNFVMSAAH CVANVNVRAV RVVLGAHNLS RREPTRQVFA NGYD PVNLLNDIVI ..30 140 150 160 170 180 LQLNGSATIN ANVQVAQLPA NGVQ CLAMGWGLLG RNRGIASVLQ ELNVTVVTSL ..9O 200 210 220 230 240 CRRSNVCTLV RGRQAGVCFG DSGSPLVCNG LIHGIASFVR GGCASGLYPD QFVN 250 260 WIDSIIQRSE DNPCPHPRDP DPASRTH The following domains have been identified in leukocyte elastase: Residues Length Domain ID 1-27 315 signal sequence 28-29 2 pro-peptide -267 238 leukocyte se As used herein, the term “relating a signal to the presence or ” of an analyte reflects the following understanding. Assay signals are typically related to the presence or amount of an analyte through the use of a standard curve ated using known concentrations of the analyte of interest. As the term is used , an assay is “configured to detect” an analyte if an assay can generate a detectable signal indicative of the presence or amount of a logically relevant concentration of the analyte.

Because an antibody epitope is on the order of 8 amino acids, an immunoassay configured to detect a marker of interest will also detect polypeptides related to the marker sequence, so long as those polypeptides contain the epitope(s) ary to bind to the antibody or antibodies used in the assay. The term “related marker” as used herein with regard to a biomarker such as one of the kidney injury markers described herein refers to one or more fragments, variants, etc., of a particular marker or its biosynthetic parent that may be detected as a ate for the marker itself or as independent biomarkers. The term also refers to one or more polypeptides present in a biological sample that are derived from the biomarker precursor complexed to onal species, such as binding proteins, receptors, n, lipids, sugars, etc.

In this regard, the d artisan will understand that the signals ed from an immunoassay are a direct result of complexes formed between one or more antibodies and the target ecule (i.e., the e) and polypeptides containing the necessary epitope(s) to which the antibodies bind. While such assays may detect the full length biomarker and the assay result be expressed as a concentration of a biomarker of interest, the signal from the assay is actually a result of all such “immunoreactive” polypeptides present in the sample. Expression of biomarkers may also be determined by means other than assays, ing protein measurements (such as dot blots, western blots, chromatographic methods, mass spectrometry, etc.) and nucleic acid measurements (mRNA quatitation). This list is not meant to be limiting.

The term “positive going” marker as that term is used herein refer to a marker that is determined to be elevated in subjects suffering from a disease or condition, ve to subjects not ing from that disease or condition. The term “negative going” marker as that term is used herein refer to a marker that is determined to be reduced in subjects suffering from a disease or condition, relative to ts not suffering from that disease or condition.

The term “subject” as used herein refers to a human or non-human organism.

Thus, the methods and compositions described herein are applicable to both human and veterinary disease. Further, while a subject is preferably a living organism, the invention described herein may be used in post-mortem analysis as well. Preferred subjects are humans, and most preferably “patients,” which as used herein refers to living humans that are receiving medical care for a disease or condition. This includes persons with no defined illness who are being investigated for signs of pathology.

Preferably, an analyte is ed in a sample. Such a sample may be obtained from a subject, or may be obtained from biological materials intended to be provided to the t. For example, a sample may be obtained from a kidney being evaluated for possible transplantation into a subject, and an analyte measurement used to evaluate the kidney for preexisting damage. Preferred samples are body fluid samples.

The term “body fluid sample” as used herein refers to a sample of bodily fluid obtained for the purpose of diagnosis, sis, fication or evaluation of a subject of interest, such as a patient or transplant donor. In certain embodiments, such a sample may be obtained for the purpose of determining the outcome of an ongoing condition or the effect of a ent regimen on a condition. Preferred body fluid samples include blood, serum, plasma, ospinal fluid, urine, saliva, sputum, and pleural effusions. In addition, one of skill in the art would realize that certain body fluid samples would be more readily analyzed following a fractionation or purification procedure, for example, tion of whole blood into serum or plasma components.

The term “diagnosis” as used herein refers to methods by which the skilled n can estimate and/or determine the ility (“a likelihood”) of whether or not a patient is suffering from a given e or condition. In the case of the present invention, “diagnosis” includes using the results of an assay, most preferably an assay, for a kidney injury marker of the present invention, optionally together with other clinical characteristics, to arrive at a diagnosis (that is, the occurrence or urrence) of an acute renal injury or ARF for the subject from which a sample was obtained and assayed.

That such a diagnosis is “determined” is not meant to imply that the diagnosis is 100% accurate. Many biomarkers are indicative of multiple conditions. The skilled clinician does not use biomarker results in an informational vacuum, but rather test results are used together with other al indicia to arrive at a diagnosis. Thus, a measured biomarker level on one side of a predetermined diagnostic threshold tes a greater hood of the occurrence of disease in the subject relative to a measured level on the other side of the predetermined stic threshold.

Similarly, a prognostic risk signals a probability (“a likelihood”) that a given course or outcome will occur. A level or a change in level of a prognostic indicator, which in turn is associated with an increased probability of morbidity (e. g., worsening renal function, future ARF, or death) is referred to as being “indicative of an increased likelihood” of an adverse outcome in a patient. 2012/052298 Marker Assays In general, immunoassays involve contacting a sample containing or suspected of containing a biomarker of interest with at least one antibody that specifically binds to the biomarker. A signal is then generated tive of the presence or amount of complexes formed by the binding of polypeptides in the sample to the antibody. The signal is then d to the presence or amount of the biomarker in the sample. Numerous methods and devices are well known to the skilled artisan for the detection and analysis of biomarkers. See, e.g., U.S. Patents 6,143,576; 6,113,855; 6,019,944; 5,985,579; ,947,124; 5,939,272; 5,922,615; 527; 5,851,776; 5,824,799; 5,679,526; 5,525,524; and 5,480,792, and The Immunoassay Handbook, David Wild, ed. Stockton Press, New York, 1994, each of which is hereby incorporated by reference in its entirety, including all tables, figures and claims.

The assay devices and methods known in the art can utilize labeled molecules in s ch, competitive, or non-competitive assay formats, to generate a signal that is related to the presence or amount of the biomarker of interest. Suitable assay s also include chromatographic, mass spectrographic, and protein “blotting” methods. Additionally, certain methods and devices, such as biosensors and optical immunoassays, may be employed to determine the presence or amount of analytes without the need for a labeled molecule. See, e.g., U.S. Patents 5,631,171; and 5,955,377, each of which is hereby incorporated by reference in its entirety, including all tables, s and . One skilled in the art also recognizes that c mentation including but not limited to Beckman ACCESS®, Abbott , Roche ELECSYS®, Dade Behring STRATUS® systems are among the assay analyzers that are capable of performing immunoassays. But any suitable immunoassay may be utilized, for e, enzyme-linked immunoassays (ELISA), radioimmunoassays (RIAs), competitive binding assays, and the like.

Antibodies or other polypeptides may be immobilized onto a variety of solid supports for use in assays. Solid phases that may be used to immobilize specific binding members include include those developed and/or used as solid phases in solid phase g assays. Examples of le solid phases include membrane filters, cellulose- based papers, beads (including polymeric, latex and paramagnetic particles), glass, silicon wafers, microparticles, nanoparticles, TentaGels, AgroGels, PEGA gels, SPOCC gels, and multiple-well plates. An assay strip could be ed by coating the antibody or a WO 43310 plurality of antibodies in an array on solid support. This strip could then be dipped into the test sample and then processed quickly through washes and detection steps to generate a measurable signal, such as a colored spot. Antibodies or other polypeptides may be bound to ic zones of assay devices either by ating directly to an assay device surface, or by indirect g. In an example of the later case, antibodies or other ptides may be immobilized on particles or other solid supports, and that solid support immobilized to the device surface.

Biological assays require methods for detection, and one of the most common methods for quantitation of results is to conjugate a detectable label to a protein or nucleic acid that has affinity for one of the components in the biological system being studied.

Detectable labels may include molecules that are themselves detectable (e.g., fluorescent moieties, electrochemical labels, metal chelates, etc.) as well as molecules that may be indirectly ed by production of a detectable reaction product (e. g., enzymes such as horseradish peroxidase, alkaline phosphatase, etc.) or by a specific binding molecule which itself may be detectable (e. g., biotin, digoxigenin, maltose, oligohistidine, 2,4- dintrobenzene, phenylarsenate, ssDNA, dsDNA, etc.).

Preparation of solid phases and detectable label conjugates often comprise the use of chemical cross-linkers. Cross-linking ts contain at least two reactive groups, and are divided generally into homofunctional cross-linkers (containing identical ve groups) and heterofunctional cross-linkers (containing non-identical reactive ).

Homobifunctional cross-linkers that couple through amines, sulfhydryls or react non- specifically are available from many commercial sources. Maleimides, alkyl and aryl halides, alpha-haloacyls and pyridyl disulfides are thiol reactive groups. Maleimides, alkyl and aryl halides, and haloacyls react with sulfhydryls to form thiol ether bonds, while pyridyl disulfides react with dryls to produce mixed disulfides. The pyridyl ide product is cleavable. Imidoesters are also very useful for protein-protein links. A variety of bifunctional linkers, each combining different attributes for successful conjugation, are commercially available.

In certain aspects, the present invention provides kits for the analysis of the described kidney injury markers. The kit ses reagents for the analysis of at least one test sample which comprise at least one antibody that a kidney injury marker. The kit can also include devices and instructions for performing one or more of the diagnostic and/or prognostic correlations described herein. Preferred kits will comprise an antibody pair for performing a sandwich assay, or a labeled species for performing a competitive assay, for the analyte. Preferably, an antibody pair comprises a first antibody conjugated to a solid phase and a second dy conjugated to a detectable label, wherein each of the first and second antibodies that bind a kidney injury marker. Most preferably each of the antibodies are monoclonal dies. The instructions for use of the kit and performing the correlations can be in the form of labeling, which refers to any written or ed material that is ed to, or otherwise anies a kit at any time during its manufacture, transport, sale or use. For example, the term labeling encompasses advertising leaflets and brochures, packaging materials, instructions, audio or video cassettes, computer discs, as well as writing imprinted directly on kits.

Antibodies The term “antibody” as used herein refers to a peptide or polypeptide d from, modeled after or substantially encoded by an immunoglobulin gene or immunoglobulin genes, or fragments thereof, capable of specifically binding an n or epitope. See, e. g. Fundamental Immunology, 3rd Edition, W.E. Paul, ed., Raven Press, NY. (1993); Wilson (1994; J. Immunol. Methods 175:267-273; Yarmush (1992) J.

Biochem. Biophys. Methods 25:85-97. The term antibody includes antigen-binding portions, i.e., "antigen binding sites," (e. g., fragments, subsequences, mentarity determining regions (CDRs)) that retain capacity to bind antigen, including (i) a Fab fragment, a lent fragment consisting of the VL, VH, CL and CH1 domains; (ii) a F(ab')2 fragment, a bivalent nt comprising two Fab fragments linked by a disulfide bridge at the hinge region; (iii) a Fd nt consisting of the VH and CH1 domains; (iv) a Fv fragment consisting of the VL and VH domains of a single arm of an antibody, (v) a dAb fragment (Ward et al., (1989) Nature 341:544-546), which consists of a VH domain; and (vi) an isolated complementarity determining region (CDR). Single chain antibodies are also included by reference in the term "antibody." Antibodies used in the immunoassays described herein preferably specifically bind to a kidney injury marker of the t invention. The term fically binds” is not intended to te that an antibody binds exclusively to its ed target since, as noted above, an antibody binds to any polypeptide displaying the epitope(s) to which the antibody binds. Rather, an antibody “specifically binds” if its affinity for its intended target is about 5-fold greater when compared to its affinity for a non-target molecule which does not display the appropriate epitope(s). Preferably the affinity of the antibody 2012/052298 will be at least about 5 fold, preferably 10 fold, more preferably 25-fold, even more preferably d, and most preferably 100-fold or more, greater for a target molecule than its affinity for a non-target molecule. In red embodiments, Preferred antibodies bind with affinities of at least about 107 M'l, and preferably between about 108 M"1 to about 109 M'l, about 109 M1 to about 1010 M'l, or about 1010 M'1 to about 1012 M'1 .

Affinity is calculated as Kd = koff/kon (koff is the dissociation rate constant, Kon is the association rate constant and Kd is the brium constant). Affinity can be determined at equilibrium by measuring the fraction bound (r) of labeled ligand at various concentrations (c). The data are graphed using the Scatchard equation: r/c = K(n-r): where r = moles of bound ligand/mole of receptor at equilibrium; c = free ligand tration at equilibrium; K = equilibrium association constant; and n = number of ligand binding sites per receptor le. By graphical analysis, r/c is plotted on the Y-axis versus r on the X-axis, thus producing a Scatchard plot. Antibody affinity measurement by Scatchard analysis is well known in the art. See, e. g., van Erp et al., J. Immunoassay 12: 425-43, 1991; Nelson and Griswold, Comput. Methods Programs Biomed. 27: 65-8, 1988.

The term “epitope” refers to an antigenic determinant capable of specific g to an antibody. Epitopes usually consist of chemically active surface ngs of molecules such as amino acids or sugar side chains and usually have specific three dimensional structural characteristics, as well as ic charge characteristics.

Conformational and nonconformational epitopes are distinguished in that the binding to the former but not the latter is lost in the ce of ring solvents.

Numerous publications discuss the use of phage display technology to produce and screen libraries of polypeptides for binding to a selected analyte. See, e. g, Cwirla et al., Proc. Natl. Acad. Sci. USA 87, 6378-82, 1990; Devlin et al., e 249, 404-6, 1990, Scott and Smith, Science 249, 386-88, 1990; and Ladner et al., U.S. Pat. No. ,571,698. A basic concept of phage display s is the establishment of a physical ation between DNA encoding a polypeptide to be screened and the polypeptide.

This physical association is provided by the phage particle, which displays a polypeptide as part of a capsid enclosing the phage genome which encodes the polypeptide. The establishment of a physical association between polypeptides and their genetic material allows simultaneous mass screening of very large numbers of phage bearing different polypeptides. Phage displaying a polypeptide with affinity to a target bind to the target and these phage are enriched by affinity screening to the target. The identity of polypeptides displayed from these phage can be determined from their respective genomes. Using these methods a polypeptide identified as having a g affinity for a desired target can then be sized in bulk by conventional means. See, e. g., U.S.

Patent No. 098, which is hereby incorporated in its entirety, including all tables, figures, and claims.

The antibodies that are ted by these methods may then be selected by first screening for ty and specificity with the purified polypeptide of st and, if required, comparing the results to the affinity and specificity of the dies with polypeptides that are desired to be excluded from binding. The screening procedure can involve immobilization of the ed polypeptides in separate wells of microtiter plates.

The solution ning a potential antibody or groups of antibodies is then placed into the respective microtiter wells and incubated for about 30 min to 2 h. The iter wells are then washed and a labeled secondary antibody (for example, an anti-mouse antibody conjugated to alkaline phosphatase if the raised antibodies are mouse antibodies) is added to the wells and incubated for about 30 min and then washed. Substrate is added to the wells and a color reaction will appear where antibody to the immobilized polypeptide(s) are present.

The antibodies so identified may then be further analyzed for affinity and specificity in the assay design selected. In the development of immunoassays for a target protein, the purified target protein acts as a standard with which to judge the ivity and specificity of the immunoassay using the antibodies that have been selected. Because the binding affinity of various antibodies may differ; certain antibody pairs (e. g., in sandwich assays) may interfere with one another sterically, etc., assay performance of an antibody may be a more important measure than te affinity and specificity of an antibody.

While the present application describes antibody-based binding assays in detail, alternatives to antibodies as g species in assays are well known in the art.

These include receptors for a particular target, aptamers, etc. Aptamers are oligonucleic acid or peptide molecules that bind to a specific target molecule. Aptamers are y created by selecting them from a large random sequence pool, but natural aptamers also exist. High-affinity aptamers containing modified nucleotides conferring improved characteristics on the ligand, such as improved in vivo ity or improved delivery characteristics. Examples of such modifications include chemical substitutions at the ribose and/or ate and/or base positions, and may include amino acid side chain functionalities.

Assay Correlations The term “correlating” as used herein in reference to the use of biomarkers refers to comparing the presence or amount of the biomarker(s) in a patient to its presence or amount in persons known to suffer from, or known to be at risk of, a given condition; or in persons known to be free of a given ion. Often, this takes the form of comparing an assay result in the form of a biomarker concentration to a predetermined threshold selected to be indicative of the occurrence or nonoccurrence of a e or the likelihood of some future outcome.

Selecting a diagnostic threshold involves, among other things, consideration of the ility of disease, distribution of true and false diagnoses at different test olds, and estimates of the consequences of treatment (or a failure to treat) based on the diagnosis. For example, when ering stering a specific therapy which is highly efficacious and has a low level of risk, few tests are needed e clinicians can accept substantial diagnostic uncertainty. On the other hand, in situations where treatment options are less effective and more risky, clinicians often need a higher degree of diagnostic certainty. Thus, cost/benefit analysis is involved in selecting a diagnostic old.

Suitable thresholds may be determined in a variety of ways. For example, one recommended diagnostic threshold for the diagnosis of acute myocardial infarction using cardiac troponin is the 97.5th percentile of the concentration seen in a normal population.

Another method may be to look at serial samples from the same patient, where a prior “baseline” result is used to monitor for temporal changes in a ker level.

Population s may also be used to select a decision threshold. Reciever Operating Characteristic (“ROC”) arose from the field of signal dectection therory developed during World War II for the analysis of radar images, and ROC analysis is often used to select a old able to best distinguish a “diseased” subpopulation from a “nondiseased” subpopulation. A false positive in this case occurs when the person tests positive, but actually does not have the disease. A false negative, on the other hand, occurs when the person tests negative, suggesting they are healthy, when they actually do have the disease. To draw a ROC curve, the true positive rate (TPR) and false positive rate (FPR) are determined as the decision threshold is varied continuously. Since TPR is lent with sensitivity and FPR is equal to 1 - icity, the ROC graph is sometimes called the ivity vs (1 - specificity) plot. A perfect test will have an area under the ROC curve of 1.0; a random test will have an area of 0.5. A threshold is selected to provide an acceptable level of specificity and sensitivity.

In this context, sed” is meant to refer to a population having one characteristic (the presence of a e or ion or the occurrence of some outcome) and “nondiseased” is meant to refer to a population lacking the characteristic. While a single decision threshold is the simplest application of such a , multiple decision thresholds may be used. For example, below a first threshold, the absence of e may be assigned with relatively high confidence, and above a second threshold the presence of disease may also be assigned with relatively high confidence. Between the two thresholds may be ered indeterminate. This is meant to be exemplary in nature only.

In addition to threshold comparisons, other methods for correlating assay results to a patient classification (occurrence or nonoccurrence of disease, likelihood of an outcome, etc.) include decision trees, rule sets, Bayesian methods, and neural network methods. These methods can produce probability values representing the degree to which a subject belongs to one classification out of a plurality of classifications.

Measures of test accuracy may be obtained as described in Fischer et (11., Intensive Care Med. 29: 1043-51, 2003, and used to determine the effectiveness of a given biomarker. These measures include sensitivity and specificity, predictive values, hood , stic odds ratios, and ROC curve areas. The area under the curve (“AUC”) of a ROC plot is equal to the probability that a classifier will rank a randomly chosen positive instance higher than a randomly chosen negative one. The area under the ROC curve may be thought of as equivalent to the Mann-Whitney U test, which tests for the median difference n scores obtained in the two groups considered if the groups are of continuous data, or to the Wilcoxon test of ranks.

As discussed above, suitable tests may exhibit one or more of the following results on these various measures: a icity of greater than 0.5, preferably at least 0.6, more preferably at least 0.7, still more preferably at least 0.8, even more preferably at least 0.9 and most preferably at least 0.95, with a corresponding sensitivity greater than 0.2, preferably greater than 0.3, more preferably greater than 0.4, still more preferably at least 0.5, even more preferably 0.6, yet more preferably greater than 0.7, still more preferably greater than 0.8, more preferably greater than 0.9, and most preferably greater than 0.95; a sensitivity of greater than 0.5, preferably at least 0.6, more preferably at least 0.7, still more preferably at least 0.8, even more preferably at least 0.9 and most preferably at least 0.95, with a corresponding specificity r than 0.2, preferably greater than 0.3, more preferably greater than 0.4, still more preferably at least 0.5, even more preferably 0.6, yet more preferably greater than 0.7, still more ably greater than 0.8, more preferably greater than 0.9, and most preferably greater than 0.95; at least 75% sensitivity, combined with at least 75% specificity; a ROC curve area of greater than 0.5, preferably at least 0.6, more preferably 0.7, still more preferably at least 0.8, even more preferably at least 0.9, and most preferably at least 0.95; an odds ratio different from 1, preferably at least about 2 or more or about 0.5 or less, more preferably at least about 3 or more or about 0.33 or less, still more preferably at least about 4 or more or about 0.25 or less, even more preferably at least about 5 or more or about 0.2 or less, and most preferably at least about 10 or more or about 0.1 or less; a positive likelihood ratio (calculated as ivity/(1-specificity)) of r than 1, at least 2, more ably at least 3, still more preferably at least 5, and most preferably at least 10; and or a negative likelihood ratio (calculated as sitivity)/specificity) of less than 1, less than or equal to 0.5, more preferably less than or equal to 0.3, and most preferably less than or equal to onal al indicia may be combined with the kidney injury marker assay (s) of the present invention. These include other biomarkers related to renal status. Examples include the following, which recite the common biomarker name, followed by the Swiss-Prot entry number for that biomarker or its parent: Actin (P68133); Adenosine deaminase binding protein (DPP4, P27487); Alpha-l-acid glycoprotein 1 (P02763); Alpha-l-microglobulin (P02760); Albumin 8); Angiotensinogenase (Renin, P00797); Annexin A2 (P07355); Beta-glucuronidase (P08236); B microglobulin 9); Beta-galactosidase 8); BMP-7 (Pl8075); Brain natriuretic peptide (proBNP, , NTproBNP; Pl6860); Calcium-binding protein Beta (SlOO-beta, P04271); Carbonic anhydrase 0); Casein Kinase 2 (P68400); Ceruloplasmin (P00450); Clusterin (P10909); Complement C3 (P01024); Cysteine-rich protein (CYR61, 000622); Cytochrome C (P99999); Epidermal growth factor (EGF, P01133); Endothelin-l (P05305); Exosomal Fetuin-A (P02765); Fatty acid-binding W0 2013/043310 protein, heart , P05413); Fatty acid-binding n, liver (P07148); Ferritin (light chain, P02793; heavy chain ); Fructose-1,6-biphosphatase (P09467); GRO-alpha (CXCLl, (P09341); Growth e (P01241); Hepatocyte growth factor (P14210); Insulin-like growth factor I (P01343); Immunoglobulin G; Immunoglobulin Light Chains (Kappa and Lambda); Interferon gamma (P01308); Lysozyme (P61626); eukin- 1alpha (P01583); Interleukin-2 (P60568); Interleukin-4 8); Interleukin-9 (P15248); eukin-12p40 (P29460); Interleukin-13 (P35225); Interleukin-16 (Ql4005); L1 cell adhesion molecule 4); Lactate dehydrogenase (P00338); Leucine Aminopeptidase (P28838); Meprin A-alpha subunit (Ql6819); Meprin A-beta subunit (Ql6820); Midkine (P21741); MIP2-alpha (CXCL2, ); MMP-2 (P08253); MMP-9 (P14780); Netrin-l (095631); Neutral endopeptidase (P08473); 0steopontin (P10451); Renal papillary antigen 1 (RPA1); Renal ary antigen 2 (RPA2); l g protein (P09455); Ribonuclease; $100 calcium-binding protein A6 (P06703); Serum Amyloid P Component (P02743); Sodium/Hydrogen ger isoform (NHE3, P48764); Spermidine/spermine N1-acetyltransferase (P21673); TGF-Betal (P01137); Transferrin (P02787); Trefoil factor 3 (TFF3, 007654); Toll-Like protein 4 (000206); Total protein; Tubulointerstitial nephritis antigen (Q9UJW2); Uromodulin (Tamm-Horsfall protein, P07911).

For purposes of risk stratification, Adiponectin (Ql5848); Alkaline phosphatase (P05186); Aminopeptidase N (P15144); CalbindinD28k (P05937); Cystatin C (P01034); 8 subunit of F1F0 ATPase (P03928); Gamma-glutamyltransferase 0); GSTa (alpha-glutathione-S-transferase, P08263); GSTpi (Glutathione-S-transferase P; GST class-pi; P09211); IGFBP-l (P08833); IGFBP-2 (P18065); IGFBP-6 (P24592); Integral membrane protein 1 (Itm1, P46977); Interleukin-6 (P05231); Interleukin-8 (P10145); Interleukin-18 (Ql4116); IP-10 (10 kDa interferon-gamma-induced protein, P02778); IRPR (IFRDl, 000458); Isovaleryl-CoA dehydrogenase (IVD, ); I- TAC/CXCLll 5); Keratin 19 7); Kim-1 (Hepatitis A virus cellular receptor 1, 043656); L-arginine:glycine amidinotransferase (P50440); Leptin (P41159); Lipocalin2 (NGAL, ); MCP-l (P13500); MIG (Gamma-interferon-induced monokine ); MIP-la (P10147); MIP-3a (P78556); MIP-lbeta (P13236); MIP-ld (Ql6663); NAG (N-acetyl-beta-D-glucosaminidase, P54802); Organic ion transporter (0CT2, 015244); 0steoprotegerin (014788); P8 protein (060356); Plasminogen activator inhibitor 1 (PAI-1, P05121); ProANP(1-98) (P01160); Protein phosphatase 1- beta (PPI-beta, P62140); Rab GDI-beta (P50395); Renal kallikrein (Q86U61 ); RT1.B-1 (alpha) chain of the integral membrane protein (Q5Y7A8); Soluble tumor necrosis factor receptor superfamily member 1A -I, Pl9438); Soluble tumor necrosis factor receptor superfamily member 1B (sTNFR-II, P20333); Tissue inhibitor of metalloproteinases 3 (TIMP-3, P35625); uPAR (Q03405) may be combined with the kidney injury marker assay result(s) of the present invention. [01 l 1] Other clinical indicia which may be combined with the kidney injury marker assay (s) of the present invention includes demographic information (e. g., , sex, age, race), medical y (e. g., family history, type of surgery, pre-existing disease such as aneurism, congestive heart failure, preeclampsia, eclampsia, diabetes us, hypertension, coronary artery disease, proteinuria, renal insufficiency, or sepsis, type of toxin re such as NSAIDs, cyclosporines, tacrolimus, aminoglycosides, foscamet, ethylene glycol, hemoglobin, myoglobin, ifosfamide, heavy metals, methotrexate, radiopaque st agents, or streptozotocin), clinical variables (e. g., blood pressure, temperature, respiration rate), risk scores (APACHE score, PREDICT score, TIMI Risk Score for UA/NSTEMI, Framingham Risk Score), a urine total protein measurement, a glomerular filtration rate, an ted glomerular filtration rate, a urine production rate, a serum or plasma creatinine concentration, a renal papillary antigen 1 (RPAl) measurement; a renal papillary antigen 2 (RPA2) ement; a urine creatinine concentration, a fractional excretion of sodium, a urine sodium tration, a urine creatinine to serum or plasma creatinine ratio, a urine specific gravity, a urine osmolality, a urine urea nitrogen to plasma urea nitrogen ratio, a plasma BUN to creatnine ratio, and/or a renal failure index calculated as urine sodium / (urine creatinine / plasma nine). Other measures of renal function which may be combined with the kidney injury marker assay result(s) are described hereinafter and in Harrison’s Principles of Internal Medicine, l7th Ed., McGraw Hill, New York, pages 1741-1830, and Current Medical Diagnosis & Treatment 2008, 47th Ed, McGraw Hill, New York, pages 785-815, each of which are hereby incorporated by reference in their entirety.

Combining assay results/clinical indicia in this manner can comprise the use of multivariate logistical regression, loglinear modeling, neural network is, n-of-m is, decision tree analysis, etc. This list is not meant to be limiting. sis of Acute Renal Failure As noted above, the terms “acute renal (or kidney) injury” and “acute renal (or kidney) failure” as used herein are defined in part in terms of changes in serum creatinine from a baseline value. Most definitions of ARF have common elements, including the use of serum creatinine and, often, urine output. Patients may present with renal dysfunction without an available baseline measure of renal function for use in this comparison. In such an event, one may estimate a baseline serum creatinine value by ng the t initially had a normal GFR. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular aries into the Bowman's capsule per unit time. Glomerular filtration rate (GFR) can be calculated by measuring any chemical that has a steady level in the blood, and is freely ed but neither reabsorbed nor secreted by the kidneys. GFR is typically expressed in units of ml/min: firms: Concentratim‘i >< {frills Flow GE? {1, z—.1. 3, Plamna mntration By normalizing the GFR to the body surface area, a GFR of approximately 75—100 ml/min per 1.73 m2 can be assumed. The rate therefore measured is the quantity of the substance in the urine that originated from a able volume of blood.

There are several different techniques used to calculate or estimate the glomerular filtration rate (GFR or eGFR). In clinical practice, however, creatinine clearance is used to measure GFR. Creatinine is produced naturally by the body (creatinine is a metabolite of creatine, which is found in muscle). It is freely filtered by the glomerulus, but also actively secreted by the renal tubules in very small amounts such that creatinine clearance timates actual GFR by 10-20%. This margin of error is acceptable considering the ease with which creatinine clearance is measured.

Creatinine nce (CCr) can be ated if values for creatinine's urine concentration (UCr), urine flow rate (V), and creatinine's plasma concentration (Pct) are known. Since the product of urine concentration and urine flow rate yields creatinine's excretion rate, nine nce is also said to be its excretion rate (UCrxV) divided by its plasma concentration. This is commonly represented mathematically as: Commonly a 24 hour urine collection is undertaken, from empty-bladder one morning to the contents of the bladder the following morning, with a comparative blood test then taken: is}? X 2514mm: volume {‘3‘-"f3'@' Pg: .261 x usria N . .

To allow comparison of s between people of different sizes, the CCr is often corrected for the body surface area (BSA) and expressed compared to the average sized man as ml/min/1.73 m2. While most adults have a BSA that approaches 1.7 (1.6-1.9), extremely obese or slim patients should have their CCr corrected for their actual BSA: {3:3 >6 ‘3. f3 (“Fill-3‘7:*«:r3'-‘s'rzrs:ts:d The accuracy of a creatinine clearance measurement (even when collection is complete) is limited because as glomerular tion rate (GFR) falls creatinine secretion is increased, and thus the rise in serum creatinine is less. Thus, creatinine ion is much greater than the filtered load, resulting in a potentially large overestimation of the GFR (as much as a twofold difference). However, for clinical purposes it is important to determine whether renal function is stable or getting worse or . This is often determined by ring serum creatinine alone. Like creatinine clearance, the serum nine will not be an accurate reflection of GFR in the non-steady-state condition of ARF. Nonetheless, the degree to which serum creatinine s from baseline will reflect the change in GFR. Serum creatinine is readily and easily measured and it is specific for renal function.

For purposes of ining urine output on a Urine output on a mL/kg/hr basis, hourly urine collection and measurement is adequate. In the case where, for example, only a cumulative 24-h output was available and no patient weights are provided, minor modifications of the RIFLE urine output criteria have been described.

For example, Bagshaw et al., Nephrol. Dial. Transplant. 23: 1203—1210, 2008, assumes an average patient weight of 70 kg, and patients are assigned a RIFLE classification based on the following: <35 mL/h (Risk), <21 mL/h (Injury) or <4 mL/h (Failure).

Selecting a Treatment Regimen Once a diagnosis is obtained, the clinician can readily select a treatment regimen that is compatible with the sis, such as initiating renal ement therapy, withdrawing delivery of compounds that are known to be damaging to the kidney, kidney transplantation, delaying or avoiding procedures that are known to be damaging to the kidney, modifying diuretic administration, initiating goal directed therapy, etc. The skilled artisan is aware of appropriate treatments for us diseases discussed in relation to the methods of sis described herein. See, e.g., Merck Manual of sis and Therapy, 17th Ed. Merck Research Laboratories, Whitehouse Station, NJ, 1999. In addition, since the methods and compositions described herein provide prognostic information, the s of the present invention may be used to monitor a course of treatment. For example, improved or worsened prognostic state may indicate that a ular treatment is or is not efficacious.

One skilled in the art readily appreciates that the present invention is well adapted to carry out the embodiments and obtain the ends and advantages mentioned, as well as those inherent therein. The examples ed herein are representative of preferred embodiments, are exemplary, and are not intended as limitations on the scope of the invention.

Example 1: Contrast-induced nephropathy sample collection The objective of this sample collection study is to collect samples of plasma and urine and clinical data from patients before and after receiving intravascular contrast media. Approximately 250 adults undergoing radiographic/angiographic ures involving intravascular administration of iodinated contrast media are enrolled. To be ed in the study, each patient must meet all of the following inclusion criteria and none of the following exclusion criteria: Inclusion Criteria males and females 18 years of age or older; oing a radiographic / angiographic procedure (such as a CT scan or coronary intervention) involving the intravascular administration of contrast media; expected to be hospitalized for at least 48 hours after contrast stration. able and g to provide written informed consent for study participation and to comply with all study procedures.

WO 43310 Exclusion Criteria renal transplant recipients; acutely ing renal function prior to the contrast procedure; already receiving dialysis r acute or chronic) or in imminent need of dialysis at enrollment; expected to undergo a major surgical procedure (such as involving cardiopulmonary bypass) or an additional imaging ure with contrast media with significant risk for further renal insult within the 48 hrs following contrast administration; participation in an interventional clinical study with an experimental therapy within the previous 30 days; known infection with human immunodeficiency virus (HIV) or a hepatitis virus.

Immediately prior to the first contrast administration (and after any pre- procedure hydration), an EDTA anti-coagulated blood sample (10 mL) and a urine sample (10 mL) are collected from each patient. Blood and urine samples are then collected at 4 (i0.5), 8 (i1), 24 (i2) 48 (i2), and 72 (i2) hrs following the last administration of contrast media during the index contrast procedure. Blood is collected via direct venipuncture or via other available venous access, such as an existing femoral sheath, l venous line, peripheral intravenous line or hep-lock. These study blood samples are processed to plasma at the al site, frozen and shipped to Astute Medical, Inc., San Diego, CA. The study urine samples are frozen and d to Astute Medical, Inc.

Serum creatinine is assessed at the site immediately prior to the first contrast administration (after any pre-procedure hydration) and at 4 (i0.5), 8 (i1), 24 (i2) and 48 (i2) ), and 72 (i2) hours ing the last administration of contrast (ideally at the same time as the study samples are obtained). In addition, each patient’s status is evaluated through day 30 with regard to additional serum and urine creatinine measurements, a need for dialysis, hospitalization status, and adverse clinical outcomes (including mortality).

Prior to contrast administration, each patient is assigned a risk based on the following assessment: systolic blood re <80 mm Hg = 5 points; intra-arterial balloon pump = 5 points; congestive heart failure (Class III-IV or y of pulmonary edema) = 5 points; age >75 yrs = 4 ; hematocrit level <39% for men, <35% for women = 3 points; diabetes = 3 points; contrast media volume = 1 point for each 100 mL; serum creatinine level >1.5 g/dL = 4 points OR estimated GFR 40—60 mL/min/ 1.73 m2 = 2 points, 20—40 mL/min/1.73 m2 = 4 , < 20 mL/min/1.73 m2 = 6 . The risks ed are as s: risk for CIN and dialysis: 5 or less total points = risk of CIN - 7.5%, risk of dialysis - 0.04%; 6—10 total points = risk of CIN - 14%, risk of is - 0.12%; 11—16 total points = risk of CIN - 26.1%, risk of dialysis - 1.09%; >16 total points = risk of CIN - 57.3%, risk of is - 12.8%.

Example 2: Cardiac surgery sample collection The objective of this sample collection study is to collect samples of plasma and urine and clinical data from patients before and after undergoing cardiovascular surgery, a procedure known to be potentially damaging to kidney function.

Approximately 900 adults undergoing such surgery are enrolled. To be enrolled in the study, each patient must meet all of the following inclusion criteria and none of the following exclusion criteria: Inclusion Criteria males and females 18 years of age or older; undergoing cardiovascular surgery; Toronto/Ottawa tive Risk Index for Renal Replacement risk score of at least 2 (Wijeysundera et al., JAMA 297: 1801-9, 2007); and able and willing to provide written informed consent for study participation and to comply with all study procedures.

Exclusion Criteria known ncy; previous renal transplantation; acutely worsening renal function prior to enrollment (e. g., any category of RIFLE criteria); already receiving dialysis (either acute or chronic) or in imminent need of dialysis at enrollment; currently enrolled in another clinical study or expected to be ed in another clinical study within 7 days of cardiac surgery that involves drug infusion or a therapeutic intervention for AKI; known infection with human immunodeficiency virus (HIV) or a hepatitis virus.

Within 3 hours prior to the first incision (and after any pre-procedure hydration), an EDTA anti-coagulated blood sample (10 mL), whole blood (3 mL), and a urine sample (35 mL) are collected from each patient. Blood and urine samples are then collected at 3 (i0.5), 6 (i0.5), 12 (i1), 24 (i2) and 48 (i2) hrs following the procedure and then daily on days 3 through 7 if the subject remains in the hospital. Blood is collected via direct venipuncture or via other available venous access, such as an existing femoral sheath, central venous line, peripheral enous line or hep-lock. These study blood samples are frozen and shipped to Astute Medical, Inc., San Diego, CA. The study urine s are frozen and shipped to Astute Medical, Inc.

Example 3: Acutely ill subject sample collection The objective of this study is to collect s from acutely ill patients.

Approximately 1900 adults expected to be in the ICU for at least 48 hours will be ed. To be enrolled in the study, each patient must meet all of the following inclusion ia and none of the following ion criteria: Inclusion Criteria males and females 18 years of age or older; Study population 1: imately 300 patients that have at least one of: shock (SBP < 90 mmHg and/or need for essor support to maintain MAP > 60 mmHg and/or documented drop in SBP of at least 40 mmHg); and sepsis; Study population 2: approximately 300 patients that have at least one of: IV antibiotics ordered in computerized physician order entry (CPOE) within 24 hours of enrollment; contrast media exposure within 24 hours of enrollment; increased Intra-Abdominal Pressure with acute decompensated heart failure; and severe trauma as the y reason for ICU admission and likely to be hospitalized in the ICU for 48 hours after enrollment; Study population 3: approximately 300 patients expected to be hospitalized through acute care setting (ICU or ED) with a known risk factor for acute renal injury (e. g. sepsis, hypotension/shock (Shock = systolic BP < 90 mmHg and/or the need for vasopressor support to maintain a MAP > 60 mmHg and/or a documented drop in SBP > 40 mmHg), major trauma, hemorrhage, or major surgery); and/or expected to be hospitalized to the ICU for at least 24 hours after enrollment; Study population 4: approximately 1000 patients that are 21 years of age or older, within 24 hours of being admitted into the ICU, ed to have an ling urinary catheter for at least 48 hours after enrollment, and have at least one of the following acute conditions within 24 hours prior to ment: (i) atory SOFA score of 2 2 (PaO2/FiO2 <300), (ii) cardiovascular SOFA score of 2 1 (MAP < 70 mm Hg and/or any vasopressor ed).

Exclusion Criteria known pregnancy; institutionalized individuals; previous renal transplantation; known acutely worsening renal function prior to enrollment (e.g., any category of RIFLE criteria) ; received dialysis (either acute or chronic) within 5 days prior to enrollment or in imminent need of dialysis at the time of enrollment; known infection with human deficiency virus (HIV) or a hepatitis virus; meets any of the following: (i) active bleeding with an anticipated need for > 4 units PRBC in a day; (ii) hemoglobin < 7 g/dL; (iii) any other condition that in the physician’s opinion would contraindicate drawing serial blood samples for clinical study purposes; WO 43310 meets only the SBP < 90 mmHg inclusion criterion set forth above, and does not have shock in the ing physician’s or pal investigator’s opinion; After obtaining informed consent, an EDTA anti-coagulated blood sample (10 mL) and a urine sample (25-50 mL) are collected from each patient. Blood and urine samples are then collected at 4 (i 0.5) and 8 (i 1) hours after st administration (if applicable); at 12 (i 1), 24 (i 2), 36 (i 2), 48 (i 2), 60 (i 2), 72 (i 2), and 84 (i 2) hours after enrollment, and thereafter daily up to day 7 to day 14 while the subject is hospitalized. Blood is collected via direct venipuncture or via other ble venous , such as an existing femoral sheath, central venous line, eral intravenous line or hep-lock. These study blood samples are processed to plasma at the al site, frozen and shipped to Astute Medical, Inc., San Diego, CA. The study urine samples are frozen and shipped to Astute Medical, Inc.

Example 4. assay format es are measured using standard sandwich enzyme immunoassay techniques. A first antibody which binds the analyte is immobilized in wells of a 96 well polystyrene microplate. Analyte standards and test samples are pipetted into the appropriate wells and any analyte t is bound by the immobilized antibody. After washing away any unbound substances, a horseradish peroxidase-conjugated second antibody which binds the analyte is added to the wells, thereby forming sandwich complexes with the analyte (if present) and the first antibody. Following a wash to remove any unbound antibody-enzyme reagent, a substrate solution comprising tetramethylbenzidine and en peroxide is added to the wells. Color develops in proportion to the amount of analyte present in the sample. The color development is stopped and the intensity of the color is measured at 540 nm or 570 nm. An analyte concentration is assigned to the test sample by comparison to a standard curve determined from the analyte standards.

Units for the concentrations reported in the following data tables are as follows: Heat shock 70 kDa protein 1 — pg/mL, Alphaantitrypsin Neutrophil elastase complex — pg/mL, Stromelysin-l:Metalloproteinase inhibitor 2 complex — pg/mL, Insulin-like growth factor 1 receptor — ng/mL, Myeloid differentiation primary response protein MyD88 — ng/mL, Neuronal cell adhesion molecule — ng/mL, and Tumor necrosis factor ligand superfamily member 10 — pg/mL. In the case of those kidney injury markers which are membrane proteins as described herein, the assays used in these examples detect soluble forms f.

Example 5. Apparently Healthy Donor and Chronic e Patient Human urine samples from donors with no known chronic or acute disease (“Apparently Healthy ”) were purchased from two s (Golden West Biologicals, Inc., 27625 Commerce Center Dr., Temecula, CA 92590 and Virginia Medical Research, Inc., 915 First Colonial Rd., Virginia Beach, VA 23454). The urine samples were shipped and stored frozen at less than -200 C. The vendors supplied demographic information for the individual donors including gender, race (Black ), smoking status and age.

Human urine samples from donors with various chronic diseases (“Chronic Disease Patients”) ing congestive heart failure, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, es mellitus and hypertension were purchased from Virginia Medical Research, Inc., 915 First Colonial Rd., Virginia Beach, VA 23454. The urine samples were shipped and stored frozen at less than -20 degrees centigrade. The vendor ed a case report form for each dual donor with age, gender, race (Black/White), smoking status and alcohol use, height, weight, chronic disease(s) diagnosis, current medications and previous surgeries.

Example 6. Use of Kidney Injury Markers for evaluating renal status in patients Patients from the intensive care unit (ICU) were enrolled in the following study. Each patient was classified by kidney status as non-injury (0), risk of injury (R), injury (I), and failure (F) according to the maximum stage reached within 7 days of enrollment as determined by the RIFLE criteria. EDTA anti-coagulated blood samples (10 mL) and a urine samples (25-30 mL) were collected from each patient at enrollment, 4 (i 0.5) and 8 (i 1) hours after contrast administration (if applicable); at 12 (i 1), 24 (i 2), and 48 (i 2) hours after ment, and thereafter daily up to day 7 to day 14 while the subject is hospitalized. Markers were each ed by standard immunoassay methods using commercially available assay ts in the urine samples and the plasma component of the blood samples collected.

Two cohorts were defined to represent a “diseased” and a “normal” population. While these terms are used for convenience, “diseased” and “normal” simply represent two s for comparison (say RIFLE 0 vs RIFLE R, I and F; RIFLE 0 vs RIFLE R; RIFLE 0 and R vs RIFLE I and F; etc.). The time “prior max stage” represents the time at which a sample is collected, relative to the time a particular t reaches the lowest disease stage as defined for that cohort, binned into three groups which are +/- 12 hours. For example, “24 hr prior” which uses 0 vs R, I, F as the two cohorts would mean 24 hr (+/— 12 hours) prior to reaching stage R (or I if no sample at R, or F if no sample at R or I).

A receiver operating characteristic (ROC) curve was generated for each biomarker measured and the area under each ROC curve (AUC) is determined. Patients in Cohort 2 were also separated according to the reason for adjudication to cohort 2 as being based on serum creatinine measurements (sCr), being based on urine output (UO), or being based on either serum creatinine measurements or urine output. Using the same example discussed above (0 vs R, I, F), for those patients adjudicated to stage R, I, or F on the basis of serum nine ements alone, the stage 0 cohort may include patients adjudicated to stage R, I, or F on the basis of urine output; for those patients adjudicated to stage R, I, or F on the basis of urine output alone, the stage 0 cohort may include patients cated to stage R, I, or F on the basis of serum creatinine measurements; and for those patients adjudicated to stage R, I, or F on the basis of serum creatinine measurements or urine , the stage 0 cohort contains only ts in stage 0 for both serum creatinine measurements and urine output. Also, in the data for patients adjudicated on the basis of serum creatinine measurements or urine output, the adjudication method which yielded the most severe RIFLE stage is used.

The ability to distinguish cohort 1 from Cohort 2 was determined using ROC analysis. SE is the standard error of the AUC, n is the number of sample or individual patients (“pts,” as indicated). Standard errors are calculated as bed in Hanley, J. A., and McNeil, B.J., The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology (1982) 143: 29-36; p values are calculated with a iled Z-test. An AUC < 0.5 is indicative of a ve going marker for the comparison, and an AUC > 0.5 is indicative of a positive going marker for the comparison. 2012/052298 Various threshold (or “cutoff’) concentrations were selected, and the associated sensitivity and specificity for distinguishing cohort 1 from cohort 2 are determined. OR is the odds ratio calculated for the particular cutoff concentration, and 95% CI is the confidence interval for the odds ratio.

Table 1: Comparison of marker levels in urine samples collected from Cohort 1 nts that did not progress beyond RIFLE stage 0) and in urine samples collected from ts at 0, 24 hours, and 48 hours prior to reaching stage R, I or F in Cohort 2.

Stromelysin-leetalloproteinase inhibitor 2 complex sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.487 0.237 0.487 0.487 0.487 0.362 Average 328 5.13 328 22.4 328 0.362 Stdev 1910 21.0 1910 65.2 1910 0.176 p(t—test) 0.47 0.49 0.81 Min 0.237 0.237 0.237 0.237 0.237 0.237 Max 13900 91.7 13900 267 13900 0.487 n (Samp) 53 19 53 19 53 2 11 (Patient) 42 19 2 19 42 2 __24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 0——_487 0487 0487 0487 ———193 111 193 0487 ———1440 235 1440 0 ——— 0-90 0-85 0——_237 0-237 0-237 0487 ———13900 530 13900 0487 ———93 5 93 2 7———3 5 73 2 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.487 0.237 0.487 0.487 0.487 0.487 Average 348 6.40 348 117 348 0.425 Stdev 2070 23.6 2070 431 2070 0.125 p(t—test) 0.53 0.62 0.74 Min 0.237 0.237 0.237 0.237 0.237 0.237 Max 13900 91.7 13900 1930 13900 0.487 n (Samp) 45 15 5 20 45 4 11 (Patient) 35 15 35 20 35 4 _________UOonly _________0-54 _________0-15 ___0-82 Cutoff 1 ________37 Sens 1 ________75% 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only Spec 1 0% 0% 0% 0% 0% 0% 44% 49% Cutoff 2 0 0 0 0 0 0 0.237 0 Sens 2 100% 100% 100% 100% 100% 100% 100% 100% Spec 2 0% 0% 0% 0% 0% 0% 44% 0% Cutoff 3 0 0 0 0 0 0 0.237 0 Sens 3 100% 100% 100% 100% 100% 100% 100% 100% Spec 3 0% 0% 0% 0% 0% 0% 44% 0% Cutoff 4 0.487 0.487 0.487 0.487 0.487 0.487 0.487 0.487 Sens 4 5% 0% 7% 21% 40% 0% 0% 0% Spec 4 77% 82% 78% 77% 82% 77% 82% 78% Cutoff 5 85.2 0.487 3.84 85.2 0.487 85.2 0.487 3.84 Sens 5 5% 0% 7% 11% 40% 0% 0% 0% Spec 5 81% 82% 80% 81% 82% 81% 82% 80% Cutoff 6 201 154 201 201 154 201 154 201 Sens 6 0% 0% 0% 5% 20% 0% 0% 0% Spec 6 91% 90% 93% 91% 90% 91% 90% 93% OR Quart 2 1.0 >3.6 5.1 0.70 0.96 >0 >21 0 p Value 1.0 <0.29 0.17 0.67 0.98 <na <0.56 na 95% C1 0f 0.058 >0.35 0.50 0.13 0.057 >na >0.18 na OR Quart2 17 na 52 3.7 16 na na na OR Quart 3 34 >10 12 1.3 1.0 >1.1 >0 3.7 p Value 0.0021 <0.98 0.030 0.70 1.0 <0.96 <na 0.29 95% C1 0f 3.6 >0.062 1.3 0.30 0.059 >0.061 >na 0.32 OR Quart3 320 na 120 6.1 17 na na 42 OR Quart46.5 >1.1 3.5 2.2 2.0 >1.2 >0 0 p Value 0.10 <0.95 0.30 0.28 0.58 <0.92 <na na 95% C1 0f 0.68 >0.064 0.32 0.52 0.17 >0.066 >na na OR Quart4 63 na 38 9.6 24 na na na Heat shock 70 kDa protein 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 277 24 277 499 277 225 Average 558 08 558 702 558 700 StdeV 1110 392 1110 906 1110 897 st) 0.58 0.62 0.83 Min 0.297 0.335 0.297 0.335 0.297 140 Max 7800 1680 7800 3860 7800 1730 11 (Sam ) 51 18 51 18 51 3 11 (Patient) 1 18 1 18 41 3 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 286 59 286 982 286 774 Average 535 863 535 861 535 774 StdeV 943 767 943 592 943 776 (t—test) 0.45 0.45 0.72 Min 0.297 217 0.297 0.335 0.297 225 Max 7800 1710 7800 1600 7800 1320 n (Samp) 90 5 90 5 90 2 11 (Patient) 71 5 71 5 71 2 “Ohr orior to AKI stage 24hr orior to AKI stage 48hr orior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 224 424 224 435 224 1680 Average 553 339 553 1260 553 1170 StdeV 1190 258 1190 2690 1190 801 p(t—test) 0.51 0.15 0.27 Min 0.297 0.335 0.297 0.335 0.297 140 Max 7800 812 7800 11800 7800 1820 n (Samp) 45 14 5 19 45 5 11 (Patient) 35 14 35 19 35 5 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.52 0.68 0.53 0.57 0.70 0.64 0.57 0.69 0.78 SE 0.080 0.14 0.090 0.080 0.13 0.079 0.18 0.21 0.13 p 0.85 0.17 0.77 0.37 0.13 0.079 0.70 0.36 0.025 nCohort 1 51 90 45 51 90 ‘ 5 51 90 45 nCohort 2 18 5 14 18 5 19 3 2 5 117 224 401 100% 100% 80% 29% 43% 67% 117 224 401 100% 100% 80% 29% 43% 67% 117 224 135 100% 100% 100% 29% 43% 38% 574 545 512 33% 50% 60% 71% 70% 71 % 755 763 664 33% 50% 60% 80% 80% 80% 1020 1020 1320 33% 50% 60% 91% 90% 90% 91 % 6.8 >22 >10 >10 0.099 <0.55 <0.98 <10 95%C1<>f—>0-056 OR Quart2 67 na na na —>1-1 p Value —<0-95 95% C1 of —>0-061 OR Quart3 n— OR Quart4 9.0 >10 >10 >36 p Value 0.057 <1.0 <0.98 <0.30 95% CI of 0.94 >0.056 >0.062 >0.32 OR Quart4 87 na na na Insulin-like growth factor 1 receptor sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0103 0.0103 0.0103 0.0169 nd nd e 0.0275 0.0137 0.0275 0.0405 nd nd StdeV 0.0922 0.0113 0.0922 0.0818 nd nd (t—test) 0.54 0.59 nd nd sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Min 0.000123 0.000172 0.000123 72 nd nd Max 0.679 0.0423 0.679 0.365 nd nd 11 (Samp) 54 17 54 19 nd nd 11 (Patient) 43 17 3 19 nd nd ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0103 0.0381 0.0103 0.0292 ———0.0278 0.0354 0.0278 0.0292 0——_0804 00263 00804 0 ——— 0-83 0-98 ———0.000123 0.000519 0.000123 0.0292 ——0.679 0.0680 0.679 0.0292 ———9l 5 91 2 ———73 5 73 2 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0103 0.0169 0.0103 0.0115 0.0103 0.0150 Average 0.0292 0.0166 0.0292 0.0335 0.0292 0.0200 Stdev 0.0988 0.0108 0.0988 0.0799 0.0988 0.0216 p(t—test) 0.65 0.86 0.87 Min 0.000123 0.000519 0.000123 0.000172 0.000123 0.00132 Max 0.679 0.0423 0.679 0.365 0.679 0.0436 n (Samp) 47 13 7 20 47 3 11 (Patient) 37 13 37 20 37 3 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.50 0.34 0.59 0.59 0.72 0.56 nd 0.81 0.63 SE 0.081 0.14 0.092 0.078 0.13 0.078 nd 0.19 0.18 p 0.98 0.25 0.33 0.23 0.10 0.47 nd 0.093 0.48 nCohort 1 54 91 47 54 91 A 7 nd 91 47 nCohort 2 17 5 13 19 5 20 nd 2 3 0.00573 0.000172 0.00454 0.00132 0.00454 nd 0.0254 0.000519 70% nd 100% 100% 36% nd 79% 30% 19 0.000172 0.00454 0.000172 0.000519 nd 0.0254 0.000519 85% nd 100% 100% % nd 79% 30% 0.000172 23 0.00454 0.000123 0.000172 0_000519 90% nd 100% 100% 19% nd 79% 30% 0.0169 nd 0.0197 0.0169 % nd 100% 33% 70% nd 71% 70% 0.0292 nd 0.0292 0.0292 % nd 0% 33% 85% nd 84% 85% 0.0388 nd 0.0423 0.0388 % nd 0% 33% 91% nd 92% 91 % OR Quart 2 1.2 >2.2 7.0 1.0 0 3.8 nd >0 >10 p Value 0.77 <0.54 0.097 1.0 na 0.14 nd <na <1.0 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only 95% CI of 0.27 >0.18 0.71 0.21 na 0.64 nd >na >0.056 OR Quart2 5.7 na 69 4.8 na 23 nd na na OR Quart 3 0.93 >0 3.5 1.0 1.0 3. 8 nd >0 >1. 1 p Value 0.93 <na 0. 30 1.0 1.0 0. 14 nd <na <0.95 95% C1 0f 0.19 >na 0.32 0.21 0.059 0.64 nd >na >0.061 OR Quart3 4.5 na 38 4.8 17 23 nd na na OR Quart 40.93 >34 5. 1 2.0 3. 3 3. 8 nd >2. 1 >10 p Value 0.93 <0.30 0. 17 0.33 0. 32 0. 14 nd <0.56 <1.0 95% C1 0f 0.19 >0.33 0.50 0.48 0.32 0.64 nd >0.18 >0.056 OR Quart4 4.5 na 52 8.7 34 23 nd na na Interstitial collagenase:Metalloproteinase inhibitor 2 complex sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.233 0.233 0.233 0.233 0.233 0.231 Average 315 0.967 315 18.9 315 0.231 StdeV 2200 3.21 2200 68.2 2200 0.00389 p(t—test) 0.54 0.56 0.84 Min 0.228 0.228 0.228 0.228 0.228 0.228 Max 16000 14.2 16000 297 16000 0.233 n (Samp) 53 19 53 19 53 2 11 (Patient) 2 19 2 19 42 2 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 mm0233 0-233 0-228 ——_184 6-08 184 0228 ———166O 13-1 1660 0 _—— 0-81 0-88 0——_228 0-228 0-228 0-228 ———16OOO 29-5 16000 0228 -——93 5 93 2 ———73 5 73 2 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 2 Cohort 1 Cohort 2 0.233 0.233 0.231 37.2 360 3.72 105 2380 6.99 0.55 0.77 0.228 0.228 0.228 384 16000 14.2 45 4 35 4 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.50 0.61 0.40 0.58 0.56 0.50 0.42 0.18 0.42 SE 0.078 0.14 0.087 0.078 0.14 0.078 0.22 0.18 0.16 0.96 0.41 0.25 0.33 0.65 0.98 0.71 0.086 0.63 t 1 53 93 45 53 93 5 53 93 5 nCohort 2 19 5 15 19 5 20 2 2 Cutoff 1 0 0.228 0 0.228 0.228 0 0 0 0 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only Sens 1 100% 80% 100% 74% 80% 100% 100% 100% 100% Spec 1 0% 37% 0% 45% 37% 0% 0% 0% 0% Cutoff 2 0 0.228 0 0 0.228 0 0 0 0 Sens 2 100% 80% 100% 100% 80% 100% 100% 100% 100% Spec 2 0% 37% 0% 0% 37% 0% 0% 0% 0% Cutoff 3 0 0 0 0 0 0 0 0 0 Sens 3 100% 100% 100% 100% 100% 100% 100% 100% 100% Spec 3 0% 0% 0% 0% 0% 0% 0% 0% 0% Cutoff4 0.233 0.233 0.233 0.233 0.233 0.233 0.233 0.233 0.233 Sens 4 5% 40% 0% 26% 20% 30% 0% 0% 25% Spec 4 77% 78% 73% 77% 78% 73% 77% 78% 73% Cutoff 5 2.99 2.13 2.99 2.99 2.13 2.99 2.99 2.13 2.99 Sens 5 5% 40% 0% 21% 20% 25% 0% 0% 25% Spec5 81% 81% 80% 81% 81% 80% 81% 81% 80% Cutoff 6 30.3 18.5 18.5 30.3 18.5 18.5 30.3 18.5 18.5 Sens 6 0% 0% 0% 11% 20% 15% 0% 0% 0% Spec 6 91% 90% 93% 91% 90% 93% 91% 90% 93% OR Quart 20.12 >10 >10 0 >10 0.43 >1. 1 >0 1. 1 p Value 0.061 <1.0 <0.047 na <1.0 0.27 <0.96 <na 0.95 95% C1 0f 0.012 >0.059 >1.0 na >0.059 0.095 >0.061 >na 0.061 OR Quart2 1.1 na na na na 1. 9 na na 20 OR Quart 3 3. 1 >2.2 >5.5 2. 6 >34 0. 30 >0 >0 0 p Value 0. 100 <0.54 <0. 15 0. 18 <0.30 0.14 <na <na na 95% C1 Of 0.80 >0.18 >0.53 0.65 >0.33 0.060 >na >na na OR Quart3 12 na na 10 na 1. 5 na na na OR Quart 40.12 >21 >75 1.0 >10 0.70 >1.2 >23 2.4 p Value 0.061 <0.56 <0.085 1.0 <1.0 0.62 <0.92 <0.51 0.50 95% C1 0f 0.012 >0.18 >0.76 0.23 >0.059 0.17 >0.066 >0.19 0.19 OR Quart4 1.1 na na 4.3 na 2.8 na na 31 72 kDa type IV collagenase:Metalloproteinase tor 2 complex 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 63.6 82.5 nd nd 610 1 1 60 nd nd 2290 3840 nd nd 0.48 nd nd 1 . 15 1 . 15 nd nd 16000 nd nd 17 nd nd 17 nd nd sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 34.8 29.2 34.8 292 34.8 918 Average 736 628 736 509 736 918 StdeV 2550 1220 2550 670 2550 1230 (t—test) 0.92 0.86 0.92 Min 1.15 1.19 1.15 1.19 1.15 51.6 Max 16000 3060 16000 1450 16000 1780 n (Samp) 88 6 88 4 88 2 11 (Patient) 72 6 72 4 72 2 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage 2012/052298 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 21.1 1.19 21.1 158 21.1 3060 Average 607 816 607 1240 607 4730 StdeV 2400 2210 2400 3680 2400 5730 p(t—test) 0.77 0.41 0.012 Min 1.15 1.15 1.15 1.15 1.15 30.3 Max 16000 8520 16000 16000 16000 11100 n (Samp) 45 15 5 19 45 3 11 (Patient) 35 15 35 19 35 3 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.52 0.59 0.53 0.54 0.64 0.55 nd 0.72 0.82 SE 0.079 0.13 0.087 0.082 0.15 0.080 nd 0.21 0.15 p 0.85 0.49 0.73 0.62 0.37 0.51 nd 0.30 0.033 nCohort 1 50 88 45 50 88 1 5 nd 88 45 nCohort 2 19 6 15 17 4 19 nd 2 3 1.15 nd 36.4 21.1 79% nd 100% 100% % nd 51% 51 % nd 36.4 21.1 100% nd 100% 100% nd 51% 51 % nd 36.4 21.1 100% nd 100% 100% nd 51% 51 % nd 295 189 nd 50% 67% nd 70% 71% nd 579 419 nd 50% 67% nd 81% 80% 1190 nd 1230 1190 16% nd 50% 67% 91% nd 91% 91% 1.0 nd >0 >1.1 —<0-95 95% CI of 0.20 nd >na >0.061 0R Quartz n— 18 nd >1.0 >0 p Value —<Ila 95% C1 of —>Ila OR Quart3 _ n— OR Quart 4 . >—-4 p Value —<0-50 95% C1 of —>0-19 OR Quart4 6.4 nd na na Neural cell adhesion molecule 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2300 3540 2300 2640 2300 2890 Average 2930 3880 2930 4210 2930 3140 StdeV 2240 050 2240 6650 2240 1810 (t—test) 7.5E—4 6.1E—4 0.55 Min 6.83 221 6.83 216 6.83 293 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Max 22000 40700 22000 55700 22000 6560 n (Samp) 460 117 60 125 460 45 n nt) 223 117 223 125 223 45 ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———2840 2390 2840 1990 ———3480 3160 3480 2390 3———360 2380 3360 1630 ——— 0-52 0-11 6——_83 216 6-83 387 ———55700 10800 55700 6110 ———1008 45 1008 25 ———374 45 374 25 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2410 3860 2410 3060 2410 2880 Average 3010 4670 3010 4630 3010 3260 StdeV 2070 4820 2070 7120 2070 1990 p(t—test) 9.0E—8 4.0E—5 0.44 Min 173 506 173 224 173 293 Max 11700 40700 11700 55700 11700 9700 n (Samp) 432 107 32 116 432 43 n (Patient) 172 107 172 116 172 43 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.61 0.40 0.66 0.56 0.46 0.58 0.56 0.37 0.56 SE 0.030 0.049 0.031 0.030 0.045 0.031 0.046 0.061 0.047 p 3.7E—4 0.044 6.1E—7 0.042 0.42 0.014 0.19 0.031 0.22 nCohort 1 460 1008 432 460 1008 A 32 460 1008 432 nCohort 2 117 39 107 125 45 116 45 25 43 2040 2150 1190 2250 71% 71% 72% 72% A 0% 47% 14% 45% 1560 1500 1110 1650 80% 80% 80% 81% 29% 28% 13% 31 % 986 485 491 881 91% 91% 92% 91% 12% 3% 2% 9% 3650 3540 4070 3650 39% 38% 16% 35% 70% 70% 70% 70% 430 4180 4960 4430 31% 31% 8% 26% 80% 80% 80% 80% 6000 5630 6470 6000 % 9% 0% 9% 90% 90% 90% 90% 1.3 0.65 1.0 1.1 0.35 0.43 1.00 0.80 95% CI of 0.72 0.22 0.25 0.40 WO 43310 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only OR Quart2 2.1 4.3 2.8 1.6 1.8 2.5 1.9 4.1 3.3 OR Quart 3 1.8 1.5 2.9 0.87 1.2 1.3 1.9 1.8 2.3 p Value 0.050 0.43 0.0021 0.65 0.67 0.43 0.15 0.36 0.083 95% CI Of 1.00 0.53 1.5 0.49 0.53 0.69 0.80 0.51 0.90 OR Quart3 3.4 4.3 5.7 1.6 2.7 2.4 4.5 6.1 5.8 OR Quart42.6 2.6 3.7 1.7 1.2 2.1 1.6 2.6 1.9 p Value 0.0015 0.052 9.9E—5 0.048 0.67 0.015 0.29 0.11 0.17 95% CI Of 1.4 0.99 1.9 1.0 0.53 1.2 0.67 0.80 0.75 OR Quart4 4.7 6.8 7.3 3.0 2.7 3.7 3.9 8.3 5.1 Tumor necrosis factor ligand superfamily member 10 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0285 0.0335 0.0285 0.0324 0.0285 0.0287 Average 2.78 1.92 2.78 2.63 2.78 1.54 StdeV 9.69 7.52 9.69 13.7 9.69 6.36 p(t—test) 0.37 0.89 0.39 Min 0.0110 0.0110 0.0110 0.0110 0.0110 0.0110 Max 92.3 63.9 92.3 134 92.3 41.7 n (Samp) 49 115 49 124 449 47 11 (Patient) 222 115 222 124 222 47 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0285 0.0317 0.0285 0.0287 ml1-03 2-84 2-16 ———11-0 3-99 11-0 8-53 _—— 0-27 0-76 ———0.0110 0.0139 0.0110 0.0110 ———159 24-4 159 41-7 --9——97 45 997 24 ———379 45 379 24 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0287 0.0335 0.0287 0.0312 0.0287 0.0287 Average 3.05 3.56 3.05 3.58 3.05 0.744 StdeV 10.6 13.1 10.6 17.5 10.6 2.23 o(t—test) 0.67 0.68 0.15 110 0.0110 0.0110 0.0139 ———92-3 134 92-3 12-3 _—19 115 419 44 11 (Patient) 175 107 175 115 175 44 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.52 0.42 0.50 0.52 0.52 0.50 0.49 0.50 0.46 SE 0.030 0.051 0.031 0.030 0.044 0.030 0.045 0.060 0.047 0.58 0.11 0.97 0.49 0.68 0.99 0.80 0.99 0.45 nCohort 1 449 997 419 449 997 19 449 997 19 nCohort 2 115 36 107 124 45 115 47 24 4 Cutoff 1 0.0239 0.0217 0.0247 0.0237 0.0247 0.0239 0.0217 0.0239 0.0227 Sens 1 70% 72% 71% 73% 71% 70% 74% 71% 70% 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only Spec 1 38% 22% 40% 35% 41% 34% 27% 37% 26% Cutoff 2 0.0205 0.0162 0.0159 0.0217 0.0217 0.0227 0.0205 0.0205 0.0205 Sens 2 80% 83% 86% 82% 82% 81% 83% 88% 84% Spec 2 22% 15% 16% 27% 22% 26% 22% 18% 19% Cutoff3 0.0139 0.0110 0.0139 0.0147 0.0147 0.0147 0.0110 0.0139 0.0147 Sens 3 93% 100% 92% 91% 91% 90% 98% 92% 91% Spec 3 8% 4% 7% 14% 11% 12% 4% 7% 12% 4 0.0526 0.0439 0.0526 0.0526 0.0439 0.0526 0.0526 0.0439 0.0526 Sens 4 16% 17% 17% 19% 18% 20% 19% 21% 18% Spec 4 73% 73% 72% 73% 73% 72% 73% 73% 72% Cutoff 5 1.17 0.327 1.42 1.17 0.327 1.42 1.17 0.327 1.42 Sens 5 14% 11% 15% 14% 13% 16% 13% 17% 11% Spec 5 80% 80% 80% 80% 80% 80% 80% 80% 80% Cutoff 6 6.80 6.49 8.01 6.80 6.49 8.01 6.80 6.49 8.01 Sens 6 9% 6% 7% 6% 4% 5% 4% 4% 2% Spec 6 90% 90% 90% 90% 90% 90% 90% 90% 90% OR Quart 2 1.0 1.3 2.7 1.7 0.62 1.8 2.3 0.66 2.5 p Value 1.0 0.58 0.0019 0.076 0.34 0.053 0.063 0.53 0.054 95% C1 0f 0.54 0.46 1.4 0.95 0.24 0.99 0.96 0.18 0.98 OR Quart2 1.8 3.9 5.0 3.1 1.6 3.2 5.6 2.4 6.3 OR Quart 3 2.3 1.5 1.4 2.7 1.9 1.6 1.6 1.5 1.6 p Value 0.0030 0.43 0.31 7.0E—4 0.10 0.10 0.35 0.43 0.33 95% C1 0f 1.3 0.53 0.72 1.5 0.89 0.91 0.61 0.53 0.61 OR Quart3 4.0 4.3 2.7 4.8 4.0 3.0 3.9 4.3 4.4 OR Quart40.68 2.2 1.6 0.94 0.62 0.96 1.3 0.83 1.5 p Value 0.25 0.11 0.18 0.85 0.34 0.89 0.63 0.76 0.44 95% C1 0f 0.35 0.84 0.81 0.49 0.24 0.50 0.48 0.25 0.54 OR Quart4 1.3 6.0 3.0 1.8 1.6 1.8 3.3 2.7 4.0 Myeloid differentiation primary response protein MyD88 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.000533 0.000171 0.000533 0.000533 0.000533 0.000165 Average 0.0182 0.0146 0.0182 0.0138 0.0182 00 StdeV 0.0708 0.0619 0.0708 0.0330 0.0708 7 p(t—test) 0.79 0.73 0.68 Min 0.000126 0.000126 0.000126 0.000126 0.000126 0.000165 Max 0.671 0.371 0.671 0.171 0.671 0.00237 11 (Sam ) 98 36 98 33 98 3 11 (Patient) 64 36 64 33 64 3 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.000533 0.000171 0.000533 0.000165 0.000533 0.000165 Average 0.0184 0.00598 0.0184 0.00792 0.0184 0.00225 StdeV 0.0636 0.0133 0.0636 0.0140 0.0636 0.00419 (t—test) 0.52 0.59 0.61 Min 0.000126 0.000126 0.000126 0.000126 26 0.000126 Max 0.671 0.0400 0.671 0.0359 0.671 0.00853 11 (Samp) 192 11 192 11 192 4 n(Patient) 114 11 114 11 114 4 “Ohr orior to AKI stage 24hr orior to AKI stage 48hr orior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 33 0.000352 0.000533 0.000533 0.000533 0.000533 Average 0.0113 0.0169 0.0113 0.0134 0.0113 0.00485 StdeV 0.0229 0.0676 0.0229 0.0332 0.0229 0.0101 p(t—test) 0.48 0.68 0.50 Min 0.000126 0.000126 0.000126 0.000126 0.000126 0.000165 Max 0.106 0.371 0.106 0.171 0.106 0.0253 n (Samp) 99 30 99 34 99 6 11 (Patient) 61 30 61 34 61 6 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.42 0.42 0.45 0.55 0.41 0.55 0.39 0.31 0.51 SE 0.057 0.092 0.061 0.059 0.093 0.058 0.18 0.15 0.12 p 0.17 0.41 0.39 0.37 0.31 0.37 0.54 0.21 0.92 nCohort 1 98 192 99 98 192 99 98 192 99 nCohort 2 36 11 30 33 11 34 3 4 6 0.000126 0.000126 0.000126 0.000171 26 O_000126 74% 100% 75% 100% A 2% 8% 11% 9% 0.000126 0.000126 0.000126 0.000126 0.000126 26 0 0.000126 94% 100% 100% 100% 9% 8% 0% 9% 0.000126 26 0.000126 0.000126 0 0.000126 94% 100% 100% 100% 9% 8% 0% 9% 33 0.00237 0.00309 0.000533 0.00237 0.00309 0.000533 0.00237 0.00309 26% 33% 25% 17% 71% 71% 70% 71% 0.0212 0.0212 0.0190 0.0212 18% 0% 0% 17% 81% 81% 80% 81% 0.0393 0.0484 0.0394 0.0393 12% 0% 0% 0% 91% 91% 90% 91% 3.2 >1.1 >1.0 1.0 0.055 <0.96 <0.99 1.0 95% CI of 0.98 >0.064 >0.062 0.13 OR Quart2 10 na na 7.7 2.1 >23 >21 0.48 p Value 0.23 <0.52 <0.55 0.56 95% CI Of 0.62 >0.19 >0.18 0.041 OR Quart3 7.1 na na 5.6 OR Quart 4 . 1.7 >0 >10 0.46 p Value 0.39 <na <0.99 0.54 95% CI of 0.50 >113. >0.062 0.039 OR Quart4 5.9 na na 5.4 Table 2: Comparison of marker levels in urine samples collected from Cohort 1 (patients that did not progress beyond RIFLE stage 0 or R) and in urine samples collected from subjects at 0, 24 hours, and 48 hours prior to reaching stage I or F in Cohort 2.

Stromelysin-leetalloproteinase tor 2 complex —24hr orior to AKI stage Cohort 2 _—— nd sCr only 24hr prior to AKI stage 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.487 10.9 nd nd Average 181 181 nd nd StdeV 1340 303 nd nd p(t—te st) 1.00 nd nd Min 0.237 0.487 nd nd Max 13900 530 nd nd 11 (Samp) 1 10 3 nd nd 11 (Patient) 85 3 nd nd n24hr orior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only 0.63 0.80 0.63 nd nd 0.77 0.082 0.15 0.085 nd nd 0.20 0.12 0.048 0.12 nd nd 0.18 97 110 82 nd nd 82 3 14 nd nd 2 0.237 0.237 0.237 nd nd 0.237 87% 100% 79% nd nd 100% 45% 44% 55% nd nd 55% 0.237 0.237 0 nd nd 0.237 87% 100% 100% nd nd 100% 45% 44% 0% nd nd 55% 0 0.237 0 nd nd 0.237 100% 100% 100% nd nd 100% 0% 44% 0% nd nd 55% 0.487 0.487 0.487 nd nd 0.487 % 67% 14% nd nd 50% 81% 82% 83% nd nd 83% 0.487 0.487 0.487 nd nd 0.487 % 67% 14% nd nd 50% 81% 82% 83% nd nd 83% 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only Cutoff 6 154 123 118 nd nd 118 Sens 6 7% 33% 7% nd nd 0% Spec 6 91% 90% 90% nd nd 90% OR Quart 2 >21 >10 2.1 nd nd >0 p Value <0.0051 <0.98 0.56 nd nd <na 95% C1 Of >2.5 >0.062 0.18 nd nd >na OR Quart2 na na 25 nd nd na OR Quart 3 >0 >0 14 nd nd >1.0 p Value <na <na 0.018 nd nd <0.97 95% C1 Of >na >na 1.6 nd nd >0.061 OR Quart3 na na 120 nd nd na OR Quart 4 >34 >21 2.1 nd nd >1.0 p Value <0.31 <0.56 0.56 nd nd <0.97 95% C1 Of >0.33 >0.18 0.18 nd nd >0.061 OR Quart4 na na 25 nd nd na Heat shock 70 kDa protein 1 sCr or UO 24hr prior to AKI stage 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 257 658 nd nd e 500 1700 nd nd StdeV 872 3070 nd nd p(t—test) 0.0023 nd nd Min 0.297 0.335 nd nd Max 7800 11800 nd nd 11 (Samp) 95 14 nd nd 11 (Patient) 73 14 nd nd 1 stage Cohort 2 _—— nd --—8hrriortoAKI stage Cohort 1 Cohort 2 ——_225 1660 ———503 1660 ———930 215 _—— 0083 0——_297 1510 ———7800 1820 -8——2 2 11 (Patient) 62 13 62 2 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.70 0.93 0.62 nd nd 0.96 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only SE 0.082 0.10 0.088 nd nd 0.10 p 0.015 2.3E—5 0.17 nd nd 5.5E—6 nCohort 1 95 107 82 nd nd 82 nCohort 2 14 3 13 nd nd 2 Cutoff 1 401 1040 246 nd nd 1340 Sens 1 71% 100% 77% nd nd 100% Spec 1 60% 91% 52% nd nd 94% Cutoff 2 246 1040 125 nd nd 1340 Sens 2 86% 100% 85% nd nd 100% Spec 2 49% 91% 33% nd nd 94% Cutoff 3 125 1040 23.5 nd nd 1340 Sens 3 93% 100% 92% nd nd 100% Spec 3 29% 91% 12% nd nd 94% Cutoff 4 529 545 512 nd nd 512 Sens 4 57% 100% 46% nd nd 100% Spec 4 71% 70% 71% nd nd 71% Cutoff 5 755 770 755 nd nd 755 Sens 5 50% 100% 38% nd nd 100% Spec 5 80% 80% 80% nd nd 80% Cutoff 6 1020 1040 1020 nd nd 1020 Sens 6 36% 100% 23% nd nd 100% Spec 6 91% 91% 90% nd nd 90% OR Quart 2 2.1 >0 0.95 nd nd >0 p Value 0.56 <na 0.96 nd nd <na 95% C1 Of 0.18 >na 0.12 nd nd >na OR Quart2 24 na 7.4 nd nd na OR Quart 34.5 >0 2.1 nd nd >0 p Value 0.19 <na 0.42 nd nd <na 95% C1 Of 0.47 >na 0.35 nd nd >na OR Quart3 43 na 13 nd nd na OR Quart 4 8.7 >3.2 2.8 nd nd >2.2 p Value 0.051 <0.32 0.26 nd nd <0.53 95% C1 0f 0.99 >0.32 0.48 nd nd >0.19 OR Quart4 76 na 16 nd nd na Insulin-like growth factor 1 receptor sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0103 0.0170 0.0103 0.0197 nd nd 0——_0238 0-0407 nd nd 0——_0708 0-0903 nd nd _—— 0-41 nd nd 0——_000123 0-00132 nd nd 0——_679 0365 nd nd -——95 15 nd nd 11 (Patient) 74 2 74 15 nd nd sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median nd nd 0.0103 0.0197 nd nd e nd nd 0.0263 0.0160 nd nd StdeV nd nd 0.0743 0.00637 nd nd (t—te st) nd nd 0.8 1 nd nd Min nd nd 0.000123 0.00862 nd nd sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Max nd nd 0.679 0.0197 nd nd 11 (Samp) nd nd 108 3 nd nd 11 (Patient) nd nd 85 3 nd nd ——24hrpriortoAKI stage 48hr prior to AKI stage ort1 Cohort 2 Cohort 1 Cohort 2 ———0.0103 0.0150 0.0103 0.0261 ———0.0248 0.0422 0.0248 0.0261 ———0.0761 0.0935 0.0761 0.0247 0-45 0-98 ———0.000123 000132 0.000123 0.00862 0——_679 0365 0679 0-0436 ———82 14 82 2 ———64 14 64 2 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only AUC 0.51 nd nd 0.62 0.57 nd nd 0.65 SE 0.21 nd nd 0.082 0.17 nd nd 0.21 p 0.96 nd nd 0.16 0.68 nd nd 0.48 nCohort 1 95 nd nd 95 108 nd nd 82 nCohort 2 2 nd nd 15 3 nd nd 2 Cutoff 1 72 nd nd 2 0.00573 nd nd 0.00454 Sens 1 100% nd nd 80% 100% nd nd 100% Spec 1 13% nd nd 40% 31% nd nd 34% Cutoff 2 0.000172 nd nd 0.00862 0.00573 nd nd 0.00454 Sens 2 100% nd nd 80% 100% nd nd 100% Spec 2 13% nd nd 40% 31% nd nd 34% Cutoff 3 0.000172 nd nd 0.00132 0.00573 nd nd 0.00454 Sens 3 100% nd nd 93% 100% nd nd 100% Spec 3 13% nd nd 27% 31% nd nd 34% Cutoff 4 0.0197 nd nd 0.0197 0.0197 nd nd 0.0197 Sens 4 50% nd nd 40% 0% nd nd 50% Spec 4 73% nd nd 73% 70% nd nd 72% Cutoff 5 0.0292 nd nd 0.0292 0.0292 nd nd 0.0292 Sens 5 50% nd nd 13% 0% nd nd 50% Spec 5 83% nd nd 83% 82% nd nd 83% Cutoff 6 0.0423 nd nd 0.0423 0.0423 nd nd 0.0423 Sens 6 0% nd nd 7% 0% nd nd 50% Spec 6 92% nd nd 92% 91% nd nd 91 % OR Quart 20 nd nd 4.3 >1.0 nd nd >1.0 p Value na nd nd 0.20 <1.0 nd nd <0.97 95% C1 Of na nd nd 0.45 >0.059 nd nd >0.061 OR Quart2 na nd nd 42 na nd nd na OR Quart 3 0 nd nd 5.9 >2.1 nd nd >0 p Value na nd nd 0.12 <0.56 nd nd <na 95% C1 Of na nd nd 0.64 >0.18 nd nd >na OR Quart3 na nd nd 54 na nd nd na OR Quart 4 0.96 nd nd 5.7 >0 nd nd >1.0 p Value 0.98 nd nd 0.13 <na nd nd <0.97 95% C1 Of 0.057 nd nd 0.61 >na nd nd >0.061 OR Quart4 16 nd nd 52 na nd nd na Alpha-l-antitrypsin Neutrophil elastase complex sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 16.2 272 16.2 43.9 16.2 10.7 Average 65.3 222 65.3 168 65.3 39.0 StdeV 120 142 120 184 120 44.5 p(t—test) 0.013 0.011 0.57 Min 0.946 14.8 0.946 2.36 0.946 1.04 Max 400 329 00 400 400 97.9 n (Samp) 93 4 93 12 93 7 n nt) 67 4 67 12 67 7 ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———17-7 206 17-7 5-41 ———73-1 206 73-1 136 ———124 274 124 229 ——— 0-14 0-40 0——_946 12-3 0-946 1-23 ———00 400 400 400 ———117 2 117 3 8———3 2 83 3 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 17.3 252 17.3 55.1 17.3 38.5 Average 80.5 198 80.5 172 80.5 46.8 StdeV 137 165 137 176 137 43.7 p(t—test) 0.15 0.048 0.55 Min 1.27 12.7 1.27 2.36 1.27 1.04 Max 400 329 00 400 400 97.9 n (Samp) 80 3 80 11 80 6 11 (Patient) 59 3 59 11 59 6 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.79 0.67 0.71 0.70 0.68 0.69 0.45 0.39 0.53 SE 0.14 0.21 0.17 0.088 0.21 0.093 0.12 0.18 0.12 p 0.032 0.43 0.22 0.024 0.38 0.043 0.64 0.54 0.80 nCohort 1 93 117 80 93 117 80 93 117 80 nCohort 2 4 2 3 12 2 11 7 3 6 .3 5.27 1.04 10.4 73% 71% 100% 83% 59% 23% 2% 34% 18.0 1.04 1.04 10.4 82% 86% 100% 83% 52% 1% 2% 34% 16.2 0.946 1.04 0 91% 100% 100% 100% A 8% 1% 2% 0% 31.9 31.8 42.5 31.9 64% 43% 33% 50% 70% 71% 70% 70% 76.0 57.4 76.0 76.0 A 5% 43% 33% 33% 80% 81% 80% 80% Cutoff 6 347 347 400 347 347 A 00 347 347 400 WO 43310 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only Sens 6 0% 0% 0% 33% 50% 0% 0% 33% 0% Spec 6 90% 91% 100% 90% 91% 100% 90% 91% 100% OR Quart 2>1.0 >10 >10 2.1 >1.0 2.0 0 0 2.0 p Value <0.98 <1.0 <1.0 0.56 <1.0 0.58 na na 0.58 95% CI of >0.062 >0.060 >0.058 0.18 >0.060 0.17 na na 0.17 OR Quart2 na na na 25 na 24 na na 24 OR Quart 3 >0 >0 >0 3.3 >0 3.1 0.31 0 0 p Value <na <na <na 0.32 <na 0.34 0.32 na na 95% C1 Of >na >na >na 0.32 >na 0.30 0.030 na na OR Quart3 na na na 34 na 33 3.2 na na OR Quart4>3.3 >10 >21 7.1 >1.0 5.8 1.0 2.1 3.2 p Value <0.32 <1.0 <0.56 0.079 <1.0 0.12 1.0 0.56 0.34 95% C1 0f >0.32 >0.060 >0.18 0.80 >0.060 0.62 0.18 0.18 0.30 OR Quart4 na na na 64 na 55 5.5 24 33 Interstitial collagenase:Metalloproteinase inhibitor 2 complex sCr or UO 24hr prior to AKI stage Cohort 1 Cohort 2 Median 0.233 0.233 Average 177 26.6 StdeV 1620 76.2 p(t—test) 0.72 Min 0.228 0.228 Max 16000 297 n (Samp) 97 15 11 (Patient) 74 15 24hr orior to AKI stage Median 0 tdeV . (t—te st) — iD o OOHHO‘xOOOUINC \leNflohort 2.233 Eax [\J\0 £11 55 AA :5meSB(D.3V 1 85 II orior to AKI stage ———— —0.233 0.233 0.233 . 0———_233 --———2 11 (Patient) 62 14 62 2 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.55 0.78 0.51 nd nd 0.34 SE 0.082 0.16 0.084 nd nd 0.21 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only p 0.51 0.079 0.94 nd nd 0.47 t 1 97 110 82 nd nd 82 nCohort 2 15 3 14 nd nd 2 Cutoff 1 0 0.228 0 nd nd 0 Sens 1 100% 100% 100% nd nd 100% Spec 1 0% 37% 0% nd nd 0% Cutoff 2 0 0.228 0 nd nd 0 Sens 2 100% 100% 100% nd nd 100% Spec 2 0% 37% 0% nd nd 0% Cutoff 3 0 0.228 0 nd nd 0 Sens 3 100% 100% 100% nd nd 100% Spec 3 0% 37% 0% nd nd 0% Cutoff 4 0.233 0.233 0.233 nd nd 0.233 Sens 4 40% 67% 36% nd nd 0% Spec 4 81% 79% 79% nd nd 79% Cutoff 5 0.233 1.35 1.26 nd nd 1.26 Sens 5 40% 67% 36% nd nd 0% Spec 5 81% 80% 80% nd nd 80% Cutoff 6 18.2 18.5 10.7 nd nd 10.7 Sens 6 20% 33% 21% nd nd 0% Spec 6 91% 91% 90% nd nd 90% OR Quart 2 0.17 >0 1.0 nd nd >0 p Value 0.12 <na 1.0 nd nd <na 95% C1 Of 0.019 >na 0.22 nd nd >na OR Quart2 1.6 na 4.6 nd nd na OR Quart 3 0.55 >1.0 0.22 nd nd >1.0 p Value 0.45 <0.98 0.19 nd nd <0.97 95% C1 0f 0.12 >0.062 0.022 nd nd >0.061 OR Quart3 2.6 na 2.1 nd nd na OR Quart41.3 >2.1 1.3 nd nd >1.0 p Value 0.74 <0.56 0.71 nd nd <0.97 95% C1 0f 0.33 >0.18 0.31 nd nd >0.061 OR Quart4 4.7 na 5.6 nd nd na 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex sCr or UO 24hr prior to AKI stage ‘ 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 28 .1 269 nd nd Average 585 1600 nd nd nd nd _——nd nd ———nd nd ———nd nd -——nd nd 11 (Patient) 72 15 nd nd sCr only 24hr prior to AKI stage 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 30.3 527 nd nd Average 817 47 nd nd StdeV 2580 245 nd nd (t—test) 0.81 nd nd Min 1.15 171 nd nd Max 16000 642 nd nd sCr only 24hr prior to AKI stage 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 n (Samp) 105 3 nd nd 11 (Patient) 84 3 nd nd riortoAKI stage ———C0h0rt1 Cohort 2 ———16-2 5640 ———624 5640 ———2060 7740 ——— 0-0023 1——_15 171 1——_6000 11100 —__80 2 —6__63 2 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.60 0.75 0.57 nd nd 0.83 SE 0.083 0.17 0.086 nd nd 0.18 p 0.22 0.14 0.40 nd nd 0.066 nCohort 1 91 105 80 nd nd 80 nCohort 2 15 3 14 nd nd 2 Cutoff 1 1.15 164 1.15 nd nd 164 Sens 1 80% 100% 79% nd nd 100% Spec 1 18% 65% 15% nd nd 68% Cutoff 2 1.15 164 0 nd nd 164 Sens 2 80% 100% 100% nd nd 100% Spec 2 18% 65% 0% nd nd 68% Cutoff 3 0 164 0 nd nd 164 Sens 3 100% 100% 100% nd nd 100% Spec 3 0% 65% 0% nd nd 68% Cutoff 4 189 295 227 nd nd 227 Sens 4 60% 67% 50% nd nd 50% Spec 4 70% 70% 70% nd nd 70% Cutoff 5 579 595 579 nd nd 579 Sens 5 33% 33% 29% nd nd 50% Spec 5 80% 80% 80% nd nd 80% Cutoff 6 1380 1700 1380 nd nd 1380 Sens 6 20% 0% 21% nd nd 50% Spec 6 90% 90% 90% nd nd 90% OR Quart 2 0.21 >0 0.61 nd nd >0 p Value 0.18 <na 0.60 nd nd <na 95% C1 Of 0.022 >na 0.092 nd nd >na OR Quart2 2.0 na 4.0 nd nd na OR Quart 3 1.0 >1.0 1.4 nd nd >1. 1 p Value 1.0 <0.98 0. 68 nd nd <097 95% CI of 0.22 >0.062 0.28 nd nd >0.061 OR Quart3 4.5 na 7.1 nd nd na OR Quart 4 1.6 >2.2 1. 8 nd nd >1.0 p Value 0.53 <054 0.48 nd nd <1.0 95% C1 0f 0.39 >0.18 0.37 nd nd >0.058 OR Quart4 6.4 na 8.4 nd nd na Neural cell adhesion molecule 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2660 3570 2660 2810 2660 2310 Average 3280 3960 3280 4330 3280 2870 StdeV 2980 2720 2980 6820 2980 2250 p(t—test) 0.087 0.014 0.39 Min 6.83 85.5 6.83 375 6.83 138 Max 48400 15000 8400 55700 48400 9700 n (Samp) 923 60 923 68 923 38 11 (Patient) 359 60 359 68 359 38 ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———2820 2620 2820 2470 ———3470 3790 3470 3290 ———3270 2950 3270 2340 ——— 0-68 0-83 6——_83 921 6-83 932 ———55700 10800 55700 8410 1———219 18 1219 16 ———39 18 439 16 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2740 4130 2740 3060 2740 2460 Average 3340 4790 3340 4830 3340 2990 StdeV 2980 4070 2980 7620 2980 2240 p(t—test) 6.9E—4 0.0014 0.50 Min 0.234 85.5 0.234 375 0.234 138 Max 48400 26600 8400 55700 48400 9700 ) 819 55 819 61 819 34 n (Patient) 285 55 285 61 285 34 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.59 0.39 0.64 0.54 0.52 0.55 0.44 0.48 0.46 SE 0.040 0.078 0.041 0.037 0.070 0.039 0.049 0.073 0.052 p 0.029 0.15 8.7E—4 0.30 0.73 0.24 0.24 0.83 0.41 nCohortl 923 1219 819 923 1219 819 923 1219 819 nCohort 2 60 15 55 68 18 61 38 16 34 2030 1250 1050 1650 70% 71% 75% 71% 34% 17% 12% 26% 1220 957 965 1180 80% 82% 81% 82% % 11% 10% 15% 1040 402 950 402 90% 92% 94% 91% 11% 2% 10% 2% 3930 3890 4060 3930 A 1% 26% 38% 26% 70% 70% 70% 70% A 750 4730 4960 4750 31% 21% 25% 21% 80% 80% 80% 80% Cutoff 6 6230 6520 6280 6230 6520 6280 6230 6520 6280 Sens 6 20% 0% 24% 16% 17% 18% 8% 6% 9% 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only Spec 6 90% 90% 90% 90% 90% 90% 90% 90% 90% OR Quart 20.65 6.1 1. 7 1.1 2.0 1.2 0.49 0.40 0.66 p Value 0.36 0.094 0.25 0.72 0.32 0.56 0.20 0.27 0.44 95% C1 Of 0.26 0.73 0.67 0.56 0.50 0.59 0.17 0.076 0.23 OR Quart2 1.6 51 4.5 2.3 8.1 2.7 1.5 2.1 1.9 OR Quart 3 1.5 2.0 1. 8 0.93 1.3 0.84 1.1 0.80 1. 1 p Value 0.27 0.57 0.25 0.84 0.70 0.67 0.82 0.74 0. 81 95% C1 Of 0.72 0.18 0.68 0.44 0.30 0.37 0.46 0.21 0.45 OR Quart3 3.3 22 4.5 2.0 6.0 1.9 2.7 3.0 2.8 ORQuart41.9 6.1 3.7 1.5 1.7 1.7 1.2 1.0 1.0 p Value 0.082 0.094 0.0029 0.24 0.48 0.16 0. 66 1.00 0.99 95% C1 Of 0.92 0.73 1.6 0.76 0.40 0.82 0.52 0.29 0.39 OR Quart4 3.9 51 8.8 3.0 7.1 3.4 2.9 3.5 2.6 Myeloid differentiation primary response protein MyD88 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.000533 0.000352 0.000533 0.000533 0.000533 7 Average 0.0158 0.0168 0.0158 0.0123 0.0158 0.00355 Stdev 0.0587 0.0263 0.0587 0.0363 0.0587 6 p(t—test) 0.96 0.78 0.64 Min 0.000126 0.000126 0.000126 0.000126 0.000126 0.000171 Max 0.671 0.0804 0.671 0.171 0.671 0.00853 11 (Samp) 197 10 197 23 197 5 11 (Patient) 118 10 118 23 118 5 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 0——_000533 0-000168 nd nd 0——_0165 0-000259 nd nd ___O0575 0000183 nd nd ___ 0-57 nd nd —__0000126 0000165 nd nd ———O671 0000533 nd nd -n__239 4 nd nd —nd—_138 4 nd nd UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 ———0.000533 0.000533 0.000533 5 ———0.0131 0.0128 0.0131 5 363 0.0370 0.0363 0.00350 _—— 0-97 0-50 ———0.000126 0.000126 0.000126 0.000171 ”“0371 0171 0371 000853 -—1_181 22 181 6 11 (Patient) 105 105 22 105 6 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.54 nd 0.53 0.46 0.34 0.46 0.62 nd 0.60 SE 0.095 nd 0.096 0.065 0.15 0.066 0.14 nd 0.12 0.71 nd 0.74 0.49 0.28 0.56 0.36 nd 0.42 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only nCohort 1 197 nd 181 197 239 197 nd 181 nCohort 2 10 nd 10 23 4 5 nd 6 Cutoff 1 0.000165 nd 0.000165 0.000126 0.000126 0.000171 nd 0.000171 Sens 1 80% nd 80% 91% 100% 80% nd 83% Spec 1 35% nd 33% 10% 10% 42% nd 41% Cutoff 2 0.000165 nd 0.000165 0.000126 0.000126 0.000171 nd 0.000171 Sens 2 80% nd 80% 91% 100% 80% nd 83% Spec 2 35% nd 33% 10% 10% 42% nd 41% Cutoff 3 0 nd 0 26 0.000126 0.000165 nd 0.000165 Sens 3 100% nd 100% 91% 100% 100% nd 100% Spec 3 0% nd 0% 10% 10% 35% nd 33% Cutoff 4 0.00167 nd 0.00309 0.00167 0.00309 0.00167 nd 0.00309 Sens 4 40% nd 40% 22% 0% 60% nd 33% Spec 4 70% nd 70% 70% 70% 70% nd 70% Cutoff 5 0.0184 nd 0.0188 0.0184 0.0188 0.0184 nd 0.0188 Sens 5 40% nd 40% 17% 0% 0% nd 0% Spec 5 80% nd 80% 80% 80% 80% nd 80% Cutoff 6 0.0387 nd 0.0366 0.0387 0.0393 0.0387 nd 0.0366 Sens 6 10% nd 10% 9% 0% 0% nd 0% Spec 6 90% nd 90% 90% 90% 90% nd 90% OR Quart 22.0 nd 1.5 0 >10 >10 nd >3.1 p Value 0.42 nd 0.67 na <0.99 <1.0 nd <0.33 95% C1 0f 0.36 nd 0.24 na >0.062 >0.061 nd >0.31 OR Quart2 12 nd 9.4 na na na nd na OR Quart 3 0 nd 0.48 3.1 >32 >32 nd >3.1 p Value na nd 0.55 0.046 <0.33 <0.32 nd <0.33 95% C1 0f na nd 0.042 1.0 >0.32 >0.32 nd >0.31 OR Quart3 na nd 5.5 9.4 na na nd na OR Quart 4 2.0 nd 2.0 1.0 >0 >10 nd >0 p Value 0.42 nd 0.42 1.0 <na <1.0 nd <na 95% C1 Of 0.36 nd 0.36 0.27 >na >0.061 nd >na OR Quart4 12 nd 12 3.7 na na nd na Table 3: Comparison of marker levels in urine samples collected within 12 hours of reaching stage R from Cohort 1 (patients that d, but did not progress beyond, RIFLE stage R) and from Cohort 2 nts that reached RIFLE stage I or F).

Tumor is factor ligand superfamily member 10 ——————Cohort2 —0.0287 0.0287 0.0257 0.0285 0.0335 0.0286 mm0.732 2_49 —0.0110 0.0110 0.0139 0.0139 0.0110 0.0110 50.6 -—I—I——_30 ——I—I——_SO At Enrollment sCr or UO sCr only UO only AUC 0.53 0.59 0.49 At Enrollment sCr or UO sCr only UO only SE 0.052 0.099 0.061 p 0.61 0.36 0.88 nCohort 1 121 47 99 nCohort 2 43 11 30 Cutoff 1 0.0239 0.0237 0.0239 Sens 1 77% 73% 73% Spec 1 35% 47% 32% Cutoff 2 0.0227 0.0227 0.0227 Sens 2 84% 82% 83% Spec 2 30% 38% 28% Cutoff 3 0.0159 0.0139 0.0159 Sens 3 91% 91% 90% Spec 3 15% 6% 15% Cutoff4 0.0439 0.0363 0.0439 Sens 4 26% 36% 20% Spec 4 73% 74% 73% Cutoff 5 0.0526 0.0439 0.0526 Sens 5 21% 36% 17% Spec 5 85% 81% 84% Cutoff 6 1.70 2.23 1.70 Sens 6 16% 18% 17% Spec 6 90% 91% 91% OR Quart 2 2.8 0.92 1.3 p Value 0.050 0.94 0.71 95% CI of 1.00 0.11 0.37 OR QuartZ 7.9 7.6 4.3 OR Quart 3 1.6 1.6 3.1 p Value 0.42 0.62 0.051 95% CI of 0.53 0.23 0.99 OR Quart3 4.6 12 9.5 OR Quart 4 1.8 2.2 0.64 p Value 0.29 0.42 0.53 95% CI of 0.61 0.33 0.16 OR Quart4 5.2 14 2.5 Table 4: Comparison of the maximum marker levels in urine samples collected from Cohort 1 (patients that did not progress beyond RIFLE stage 0) and the maximum values in urine samples collected from ts between enrollment and 0, 24 hours, and 48 hours prior to reaching stage F in Cohort 2.

Stromelysin-leetalloproteinase inhibitor 2 complex ——————— ——————m_ ——————_ _—————— —___—— n (Patlent) 42 8 1 2 8 42 3 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.487 5.71 0.487 5.71 nd nd Average 238 136 238 136 nd nd StdeV 1630 263 1630 263 nd nd p(t—test) 0.90 0.90 nd nd Min 0.237 0.487 0.237 0.487 nd nd Max 13900 530 13900 530 nd nd 11 (Samp) 73 4 73 4 nd nd 11 (Patient) 73 4 73 4 nd nd ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 7 0-487 0-487 0-487 ———35 53-8 435 0487 ———2350 119 2350 0 ——— 0-72 0-75 0——_237 0-487 0-237 0-487 ———13900 267 13900 0487 ———35 5 35 3 ———35 5 35 3 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only AUC 0.68 0.76 0.69 0.68 0.76 0.56 nd 0.63 SE 0.11 0.14 0.14 0.11 0.14 0.18 nd 0.18 p 0.11 0.076 0.17 0.11 0.076 0.74 nd 0.48 nCohort 1 42 73 35 42 73 42 nd 35 nCohort 2 8 4 5 8 4 3 nd 3 Cutoff1 0.237 0.237 0.237 0.237 0.237 0.237 nd 0.237 Sens 1 100% 100% 100% 100% 100% 100% nd 100% Spec 1 31% 42% 46% 31% 42% 31% nd 46% Cutoff 2 0.237 0.237 0.237 0.237 0.237 0.237 nd 0.237 Sens 2 100% 100% 100% 100% 100% 100% nd 100% Spec 2 31% 42% 46% 31% 42% 31% nd 46% Cutoff 3 0.237 0.237 0.237 0.237 0.237 0.237 nd 0.237 Sens 3 100% 100% 100% 100% 100% 100% nd 100% Spec 3 31% 42% 46% 31% 42% 31% nd 46% Cutoff 4 0.487 0.487 0.487 0.487 0.487 0.487 nd 0.487 Sens 4 38% 50% 20% 38% 50% 0% nd 0% Spec 4 81% 82% 80% 81% 82% 81% nd 80% Cutoff 5 0.487 0.487 0.487 0.487 0.487 0.487 nd 0.487 Sens 5 38% 50% 20% 38% 50% 0% nd 0% Spec 5 81% 82% 80% 81% 82% 81% nd 80% Cutoff 6 261 154 201 261 154 261 nd 201 Sens 6 25% 25% 20% 25% 25% 0% nd 0% Spec 6 90% 90% 91% 90% 90% 90% nd 91 % OR Quart 2 >75 >22 >67 >75 >22 >41 nd >3.9 p Value <0.090 <0.53 <0.12 <0.090 <0.53 <0.25 nd <0.28 95% CI Of >0.73 >0.19 >0.60 >0.73 >0.19 >0.36 nd >0.33 OR Quart2 na na na na na na nd na OR Quart 3 >0 >0 >0 >0 >0 >0 nd >0 p Value <na <na <na <na <na <na nd <na 95% C1 Of >na >na >na >na >na >na nd >na OR Quart3 na na na na na na nd na OR Quart4>3.6 >21 >1.1 >36 >21 >0 nd >0 p Value <0.30 <0.56 <0.94 <0.30 <0.56 <na nd <na 2012/052298 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only 95% CI of >032 >0.18 >0.060 >032 >0.18 >0.060 >na nd >na OR Quart4 na na na na na na na nd na Heat shock 70 kDa protein 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 338 1320 338 1320 338 1320 Average 633 2600 633 2600 633 4450 StdeV 1230 080 1230 4080 1230 6370 p(t—test) 0.013 0.013 0.0012 Min 0.297 250 0.297 250 0.297 250 Max 7800 11800 7800 11800 7800 11800 n (Samp) 1 7 1 7 41 3 11 (Patient) 1 7 1 7 41 3 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 —E_—‘08 1300 nd nd ———620 1140 nd nd ———1040 648 nd nd _—— 0-33 nd nd 0——_297 250 nd nd ———7800 1710 nd nd -—71 4 nd nd ——_71 4 nd nd UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 277 934 277 934 277 1320 Average 664 3480 664 3480 664 4450 StdeV 1330 5560 1330 5560 1330 6370 p(t—test) 0.013 0.013 0.0031 Min 0.297 250 0.297 250 0.297 250 Max 7800 11800 7800 11800 7800 11800 n (Samp) 35 35 4 35 3 11 (Patient) 35 35 4 35 3 orior to AKI stage orior to AKI stage orior to AKI stage sCr only sCr only sCr only 0.80 0.80 nd 0.14 0.14 nd 0.027 0.027 nd 71 71 nd 4 4 nd 1040 1040 nd 75% 75% nd 90% 90% nd 245 245 nd 100% 100% nd 41% 41% nd 245 245 nd 100% 100% nd 41% 41% nd 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only Cutoff 4 596 627 596 596 627 596 596 nd 596 Sens 4 71% 75% 50% 71% 75% 50% 67% nd 67% Spec4 71% 70% 71% 71% 70% 71% 71% nd 71% Cutoff5 811 812 755 811 812 755 811 nd 755 Sens 5 71% 75% 50% 71% 75% 50% 67% nd 67% Spec 5 80% 80% 80% 80% 80% 80% 80% nd 80% Cutoff 6 1150 1040 1340 1150 1040 1340 1150 nd 1340 Sens 6 57% 75% 25% 57% 75% 25% 67% nd 33% Spec 6 90% 90% 91% 90% 90% 91% 90% nd 91% OR >1.1 >10 >10 >1.1 >10 >10 >1.1 nd >1.0 p Value <0.95 <1.0 <1.0 <0.95 <1.0 <1.0 <0.95 nd <1.0 95% C1 Of >0.061 >0.058 >0.054 >0.061 >0.058 >0054 >0.060 nd >0054 OR Quart2 na na na na na na na nd na OR Quart 3>1.1 >0 >10 >1.1 >0 >10 >0 nd >0 p Value <0.95 <na <1.0 <0.95 <na <1.0 <na nd <na 95% C1 Of >0.061 >na >0.054 >0.061 >na >0.054 >na nd >na OR Quart3 na na na na na na na nd na OR Quart 4>8.6 >3.4 >2.2 >86 >34 >2.2 >2.4 nd >2.2 p Value <0.072 <O.31 <0.54 <0.072 <O.31 <0.54 <0.49 nd <0.54 95% C1 Of >0.83 >0.32 >0.17 >0.83 >0.32 >0.17 >0.19 nd >0.17 OR Quart4 na na na na na na na nd na Interstitial collagenase:Metalloproteinase inhibitor 2 complex sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.233 6.57 0.233 6.57 0.233 0.228 Average 396 8.1 396 48.1 396 2.21 StdeV 2470 102 2470 102 2470 3.43 p(t—test) 0.69 0.69 0.79 Min 0.228 0.228 0.228 0.228 0.228 0.228 Max 16000 297 16000 297 16000 6.17 n (Samp) 2 8 2 8 42 3 11 (Patient) 2 8 2 8 42 3 48hr orior to AKI stage Cohort 1 Cohort 2 nd nd nd nd nd nd nd nd nd nd nd nd nd nd nd nd “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 mm6-17 0-233 0228 m‘62 69-6 462 2-21 ———2700 129 2700 3-43 _—O— 0-75 0-77 ———O228 0228 0-228 0-228 —;5—§—16000M(Samp) 297 16000 6-17 n 5 35 3 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 11 (Patient) 35 5 35 5 35 3 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.68 0.77 0.59 0.68 0.77 0.59 0.41 nd 0.35 SE 0.11 0.14 0.14 0.11 0.14 0.14 0.18 nd 0.18 p 0.12 0.055 0.51 0.12 0.055 0.51 0.63 nd 0.41 nCohort 1 42 73 35 42 73 35 42 nd 35 nCohort 2 8 4 5 8 4 5 3 nd 3 0 nd 0 100% nd 100% 0% nd 0% 0 nd 0 100% nd 100% 0% nd 0% 0 nd 0 100% nd 100% 0% nd 0% 0.233 nd 0.233 33% nd 33% 76% nd 71% 6.97 nd 7.29 0% nd 0% 81% nd 80% .3 nd 18.5 0% nd 0% 90% nd 91% 0 nd 0 na nd na 95% CI of na nd na OR Quart2 na nd na 0 nd 0 p Value na nd na 95% CI of na nd na OR Quart3 . . na nd na OR Quart 4 . —-6 p Value 0_48 95% CI of 0.19 nd 0.19 32 nd 34 72 kDa type IV enase:Metalloproteinase inhibitor 2 complex sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 117 11 117 411 117 269 Average 756 2460 756 2460 756 685 StdeV 2540 5500 2540 5500 2540 961 (t—test) 0.17 0.17 0.96 Min 1.15 1.15 1.15 1.15 1.15 1.15 Max 16000 16000 16000 16000 16000 1780 n (Samp) 0 8 0 8 40 3 11 (Patient) 0 8 0 8 40 3 “_24hroriortoAKI stage 48hr orior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 110 398 110 398 nd nd Average 889 402 889 402 nd nd StdeV 2800 219 2800 219 nd nd p(t—test) 0.73 0.73 nd nd Min 1.15 171 1.15 171 nd nd Max 16000 642 16000 642 nd nd 11 (Samp) 72 4 72 4 nd nd 11 (Patient) 72 4 72 4 nd nd ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 4 295 57-4 269 7———72 3670 772 685 ———2710 6930 2710 961 ——— 0-083 0-96 1——_15 1-15 1-15 1-15 ———16000 16000 16000 1780 ———35 5 35 3 ———35 5 35 3 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only AUC 0.68 0.69 0.68 0.68 0.69 0.56 nd 0.57 SE 0.11 0.15 0.14 0.11 0.15 0.18 nd 0.18 p 0.099 0.21 0.21 0.099 0.21 0.73 nd 0.69 nCohort 1 40 72 35 40 72 40 nd 35 nCohort 2 8 4 5 8 4 3 nd 3 Cutoff 1 234 234 234 234 234 0 nd 0 Sens 1 75% 75% 80% 75% 75% 100% nd 100% Spec 1 68% 64% 69% 68% 64% 0% nd 0% Cutoff 2 164 164 234 164 164 0 nd 0 Sens 2 88% 100% 80% 88% 100% 100% nd 100% Spec 2 57% 57% 69% 57% 57% 0% nd 0% Cutoff 3 0 164 0 0 164 0 nd 0 Sens 3 100% 100% 100% 100% 100% 100% nd 100% Spec 3 0% 57% 0% 0% 57% 0% nd 0% Cutoff 4 398 419 398 398 419 398 nd 398 Sens 4 50% 50% 40% 50% 50% 33% nd 33% Spec 4 70% 71% 71% 70% 71% 70% nd 71% Cutoff 5 615 656 579 615 656 615 nd 579 Sens 5 38% 0% 40% 38% 0% 33% nd 33% Spec 5 80% 81% 80% 80% 81% 80% nd 80% Cutoff 6 1230 1380 1230 1230 1380 1230 nd 1230 Sens 6 25% 0% 40% 25% 0% 33% nd 33% Spec 6 90% 90% 91% 90% 90% 90% nd 91 % OR Quart 2 0 >0 0 0 >0 0 nd 0 p Value na <na na na <na na nd na 95% C1 Of na >na na na >na na nd na OR Quart2 na na na na na na nd na OR Quart 3 5.5 >3.6 2.2 5.5 >3.6 0.90 nd 1.0 p Value 0.16 <0.29 0.54 0.16 <0.29 0.94 nd 1.0 95% C1 0f 0.51 >0.34 0.17 0.51 >0.34 0.049 nd 0.053 OR Quart3 59 na 30 59 na 17 nd 19 OR Quart43.7 >1.1 2.2 3.7 >1.1 0.90 nd 0.89 p Value 0.29 <0.97 0.54 0.29 <0.97 0.94 nd 0.94 2012/052298 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only 95% CI of 0.32 >0.061 0.17 0.32 >0.061 0.17 0.049 nd 0.047 OR Quart4 42 na 30 42 na 30 17 nd 17 Neural cell adhesion molecule 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2820 940 2820 4490 2820 3900 Average 3370 6950 3370 6450 3370 4660 StdeV 2580 9680 2580 9690 2580 2330 p(t—test) 1.0E—5 1.4E—4 0.053 Min 6.83 171 6.83 171 6.83 1650 Max 22000 55700 22000 55700 22000 9700 n (Samp) 223 30 223 30 223 16 11 (Patient) 223 30 223 30 223 16 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ——_3740 4080 3740 5050 —l—l—‘470 4510 4470 5290 _—470 2210 4470 1870 _—— 0-97 0-63 6——_83 171 6-83 3280 ———557OO 7860 55700 7860 -——374 13 374 7 ———374 13 374 7 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 3220 5250 3220 5050 3220 4490 Average 3650 8910 3650 8250 3650 4750 StdeV 2320 11500 2320 11500 2320 2360 p(t—test) 2.8E—7 6.5E—6 0.090 Min 85 1700 85 1120 485 1650 Max 11700 55700 11700 55700 11700 9700 n (Samp) 172 23 172 23 172 14 11 (Patient) 172 23 172 23 172 14 orior to AKI stage orior to AKI stage orior to AKI stage sCr only sCr only sCr only 0.58 0.57 0.67 0.084 0.084 0.11 0.34 0.38 0.13 374 374 374 13 13 7 3410 3250 3970 77% 77% 71% 46% 44% 56% 3250 2870 3720 85% 85% 86% 44% 37% 50% 2200 2200 3250 92% 92% 100% 27% 27% 44% 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only Cutoff 4 3940 5270 4360 3940 5270 3940 5270 4360 Sens 4 63% 31% 65% 57% 31% 50% 29% 50% Spec 4 70% 70% 70% 70% 70% 70% 70% 70% Cutoff 5 4960 6450 5580 4960 6450 4960 6450 5580 Sens 5 50% 23% 48% 47% 23% 38% 29% 36% Spec 5 80% 80% 80% 80% 80% 80% 80% 80% Cutoff 6 6160 7760 6670 6160 7760 6160 7760 6670 Sens 6 33% 15% 35% 30% 15% 25% 29% 21% Spec 6 90% 90% 90% 90% 90% 90% 90% 90% OR Quart 2 1.5 4.1 4.2 2.1 4.1 2.0 >2.0 0.98 p Value 0.65 0.21 0.21 0.31 0.21 0.58 <0.56 0.98 95% C1 Of 0.25 0.45 0.45 0.50 0.45 0.18 >0.18 0.13 OR QuartZ 9.5 37 39 8.8 37 23 na 7.3 OR Quart 3 5.1 5.2 7. 8 2.1 5.2 6.4 >31 2.7 p Value 0.043 0.14 0.059 0.31 0.14 0.089 <0.33 0.25 95% C1 Of 1.1 0.59 0.93 0.50 0.59 0.75 >0.32 0.49 OR Quart3 25 45 66 8.8 45 55 na 15 OR Quart 4 10 3.0 14 6.1 3.0 7.7 >20 2. 6 p Value 0.0027 0. 34 0.014 0.0061 0. 34 0.061 <0.57 0.27 95% C1 Of 2.2 0.31 1.7 1.7 0.31 0.91 >0.18 0.48 OR Quart4 46 30 110 22 30 64 na 14 Tumor necrosis factor ligand superfamily member 10 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0363 0.348 0.0363 0.338 0.0363 0.336 Average .58 11.4 .58 10.8 4.58 1.86 StdeV 13.0 31.2 13.0 31.3 13.0 2.64 p(t—test) 0.032 0.048 0.40 Min 0.0110 0.0159 0.0110 0.0159 0.0110 0.0159 Max 92.3 134 92.3 134 92.3 8.63 n (Samp) 222 30 222 30 222 16 11 (Patient) 222 30 222 30 222 16 1 stage 48hr rior to AKI stage C C Cohort 2 Cohort 1 Cohort 2 - 00410 00410 0636 - 2-45 5-75 2-67 3.54 16.4 3.52 0.47 0.62 0.0159 0.0110 0.0159 9.58 159 8.63 13 379 7 13 379 7 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0439 0.670 0.0439 0.336 ——_67 13-4 5-67 1-74 3 35-4 15-3 2-70 _—0— 0-064 0-34 ———0.0110 0.0217 0.0110 0.0239 ——23—923M(Samp) 175 134 92-3 9-58 n 175 23 175 14 2012/052298 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 11 (Patient) 175 23 175 23 175 14 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.63 0.55 0.63 0.61 0.52 0.61 0.59 0.56 0.56 SE 0.057 0.084 0.066 0.058 0.082 0.066 0.077 0.11 0.082 p 0.020 0.51 0.050 0.047 0.84 0.10 0.24 0.60 0.49 t 1 222 379 175 222 379 175 222 379 175 nCohort 2 30 13 23 30 13 23 16 7 14 0.0285 0.0392 0.0335 75% 71% 71 % 41% 49% 39% 0.0247 0.0217 0.0247 81% 86% 86% 39% 20% 30% 0.0237 0.0147 0.0239 94% 100% 93% 38% 8% 30% 0.775 1.53 1.42 44% 43% 36% 70% 70% 70% _4-69 80% 80% 80% 80% .0 11.8 16.4 15.0 13% 0% 0% 0% 90% 90% 90% 90% _>8-2 —<0-053 95%C1<>f—>0-97 OR Quart2 22 38 na na —>3-2 p Value —<0-32 95%C1<>f—>0-32 OR Quart3 17 47 9.3 na OR Quart 4 3.8 6.4 0.99 >4.3 p Value —<0-20 95% CI of 0.75 0.75 0.14 >0.46 OR Quart4 19 55 7.2 na Table 5: Comparison of marker levels in EDTA samples collected from Cohort 1 (patients that did not progress beyond RIFLE stage 0) and in EDTA samples collected from subjects at 0, 24 hours, and 48 hours prior to reaching stage R, I or F in Cohort 2.

Heat shock 70 kDa protein 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 641 1370 641 1200 641 2350 Average 1400 2760 1400 1990 1400 2240 Stdev 2010 3320 2010 2130 2010 2100 p(t—test) 0.057 0.25 0.26 WO 43310 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Min 0.288 0.288 0.288 128 0.288 54.3 Max 10000 10700 10000 9450 10000 6660 n (Samp) 54 14 54 24 54 9 11 (Patient) 53 14 53 24 53 9 ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———840 1240 840 1720 ———1580 1240 1580 1470 ———2190 1030 2190 1030 ——— 0-83 0-93 0——_288 514 0288 340 ———10700 1970 10700 2350 ———111 2 111 3 ———93 2 93 3 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 641 1370 641 1220 641 963 Average 1390 2740 1390 2040 1390 2010 StdeV 1860 3550 1860 2110 1860 2200 p(t—test) 0.073 0.18 0.38 Min 0.288 0.288 0.288 128 0.288 54.3 Max 10000 10700 10000 9450 10000 6660 n (Samp) 48 12 8 25 48 9 11 (Patient) 44 12 4 25 44 9 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.61 0.75 0.58 0.66 0.59 0.66 0.65 0.62 0.59 SE 0.088 0.17 0.095 0.070 0.21 0.070 0.11 0.18 0.11 p 0.21 0.13 0.43 0.023 0.69 0.025 0.16 0.49 0.39 nCohort 1 54 11 1 48 54 111 A 8 54 11 1 48 nCohort 2 14 3 12 24 2 25 9 3 9 837 500 336 310 72% 78% 100% 78% 54% 44% 31% 38% 664 310 336 248 80% 89% 100% 89% 52% 37% 31% 29% 310 48.9 336 48.9 92% 100% 100% 100% 38% 11% 31 % 12% 1500 1370 1500 1500 A 8% 56% 67% 44% 71% 70% 70% 71 % 2700 2700 2550 2700 24% 33% 0% 33% 81% 81% 80% 81% 3630 3540 3540 3630 12% 11% 0% 11% 92% 91% 90% 92% OR Quart 20.62 >0 0.62 3.6 >1.0 5.1 2.0 >1.0 3.5 p Value 0.63 <na 0.63 0.15 <0.98 0.068 0.59 <1.0 0.30 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only 95% CI of 0.090 >na 0.087 0.63 >0.062 0.89 0.16 >0.060 0.32 OR Quart2 4.3 na 4.3 21 na 29 25 na 39 OR Quart 3 1.0 >1.0 1.0 5.0 >0 6.4 0.93 >0 1.0 p Value 1.0 <0.98 1.0 0.071 <na 0.036 0.96 <na 1.0 95% CI Of 0.17 >0.062 0. 17 0.87 >na 1.1 0.053 >na 0.056 OR Quart3 5.8 na 6.0 28 na 36 16 na 18 OR Quart 42.5 >2. 1 1. 5 7.0 >10 5. 8 6.4 >2 1 4.7 p Value 0.25 <0.56 0. 67 0.026 <1.0 0.046 0.11 <0.56 0.19 95% CI Of 0.52 >0.18 0.26 1.3 >0.060 1.0 0.65 >0.18 0.46 OR Quart4 13 na 8.0 38 na 33 63 na 49 Insulin-like growth factor 1 receptor sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0498 0.0502 0.0498 0.0556 0.0498 0.0331 Average 0.207 0.622 0.207 0.470 0.207 0.899 StdeV 0.797 3.22 0.797 2.43 0.797 4.04 p(t—test) 0.28 0.38 0.15 Min 9.84E—5 0.000208 5 0.000211 9.84E—5 0.000208 Max 6.23 18.2 6.23 14.8 6.23 19.4 n (Samp) 79 32 79 37 79 23 11 nt) 70 32 70 37 70 23 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0498 0.0595 0.0498 0.0398 mm1-92 0-124 2-20 0——_523 5-22 0-523 6-46 _——1-4E-5 2-5E-5 ———9.84E—5 0.000211 9.84E—5 0.0214 6——_23 14-8 6-23 19-4 -—_187 8 187 9 ——_126 8 126 9 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 2 Cohort 1 Cohort 2 0.0556 0.0498 0.0354 0.589 0.233 0.0641 . 3.27 0.851 0.126 _—— 0-39 0-42 _2—:—. 0.000211 0.000208 0.000208 - 20-5 6-23 0-543 39 69 17 39 57 17 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.48 0.34 0.51 0.55 0.50 0.55 0.40 0.49 0.38 SE 0.061 0.11 0.065 0.058 0.10 0.058 0.070 0.099 0.080 0.72 0.14 0.82 0.37 0.98 0.35 0.17 0.93 0.14 nCohort 1 79 187 69 79 187 69 79 187 69 nCohort 2 32 8 28 37 8 39 23 9 17 Cutoff1 0.0219 0.0137 0.0398 0.0373 0.00497 0.0373 0.0212 0.0283 0.0212 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only Sens 1 72% 75% 71% 73% 75% 83% 78% 76% Spec 1 28% 14% 46% 43% 9% 24% 28% 23% Cutoff 2 0.0178 0.000208 0.0212 0.0251 0.000211 0.0212 0.0219 0.000224 Sens 2 81% 88% 82% 81% 88% 83% 89% 82% Spec 2 20% 3% 23% 28% 5% 24% 23% 7% Cutoff 3 0.0134 0.000172 0.0134 0.00497 0.000208 0.000208 0.0212 0.000208 Sens 3 91% 100% 93% 92% 100% 96% 100% 94% Spec 3 16% 1% 14% 10% 3% 3% 18% 3% Cutoff 4 0.0839 0.0729 0.0839 0.0839 0.0729 0.0839 0.0729 0.0839 Sens 4 16% 12% 21% 27% 25% 9% 33% 6% Spec 4 73% 70% 72% 73% 70% 73% 70% 72% Cutoff 5 0.0986 0.0876 0.101 0.0986 0.0876 0.0986 0.0876 0.101 Sens 5 12% 12% 14% 24% 25% 9% 22% 6% Spec5 81% 80% 81% 81% 80% 81% 80% 81% 6 0.135 0.133 0.176 0.135 0.133 0.135 0.133 0.176 Sens 6 12% 12% 7% 14% 25% 9% 11% 6% Spec6 91% 90% 91% 91% 90% 91% 90% 91% OR Quart 22.0 1.0 1.0 1.4 0 3.8 0.49 8.4 p Value 0.24 1.0 1.0 0.56 na 0.13 0.57 0.060 95% C1 Of 0.62 0.061 0.27 0.44 na 0.69 0.043 0.91 OR Quart2 6.7 16 3.7 4.5 na 21 5.6 77 OR Quart 3 1.5 2.0 2. 1 1.9 0.98 6.4 2.1 6.2 p Value 0.54 0.57 0.22 0.26 0.98 0.028 0.41 0.11 95% C1 Of 0.43 0.18 0. 63 0.62 0. 19 1.2 0.36 0.66 OR Quart3 5.0 23 7. 3 6.0 5. 1 33 12 58 ORQuart41.5 4.4 0.95 1.7 0.64 3.8 1.0 6.6 p Value 0.49 0.20 0.94 0. 39 0.63 0.13 1.0 0.10 95% C1 Of 0.45 0.47 0.26 0.53 0.10 0.69 0. 14 0.70 OR Quart4 5.2 41 3.5 5.2 4.0 21 7.4 62 Neural cell adhesion molecule 1 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 183000 192000 183000 180000 183000 172000 191000 193000 191000 185000 191000 179000 67000 79300 78800 79300 59800 0.83 0.64 0.48 63300 1370 190 1370 49200 506000 520000 297000 55 122 25 55 88 25 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 181000 199000 181000 210000 181000 179000 Average 184000 200000 184000 227000 184000 180000 StdeV 70200 62800 70200 97800 70200 54800 (t—test) 0. 38 0.030 0.87 Min 190 118000 190 129000 190 108000 Max 520000 316000 520000 506000 520000 280000 11 (Samp) 291 16 291 14 291 9 11 (Patient) 164 16 164 14 164 9 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 180000 182000 180000 180000 180000 172000 Average 189000 187000 189000 176000 189000 178000 StdeV 81700 69000 81700 63300 81700 59400 p(t—test) 0.92 0.32 0.57 Min 1080 63300 1080 190 1080 49200 Max 520000 371000 520000 337000 520000 297000 n (Samp) 124 43 124 57 124 23 n (Patient) 81 43 81 57 81 23 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.53 0.58 0.50 0.48 0.64 0.48 0.48 0.49 0.49 SE 0.048 0.077 0.051 0.047 0.082 0.047 0.064 0.099 0.066 p 0.59 0.30 0.98 0.72 0.098 0.63 0.71 0.90 0.84 nCohort 1 122 291 124 122 291 124 122 291 124 t 2 52 16 43 55 14 57 25 9 23 152000 160000 141000 151000 175000 144000 147000 144000 147000 70% 72% 78% 74% % 27% 26% 28% 134000 125000 130000 133000 164000 123000 125000 115000 125000 81% 80% 89% 83% 12% 14% 14% 15% 106000 118000 105000 107000 133000 107000 115000 107000 115000 91% 92% 100% 91 % % 11% 11% 12% 212000 207000 209000 212000 207000 209000 212000 207000 209000 % 32% 22% 35% 70% 70% 70% 70% 227000 227000 228000 227000 227000 228000 227000 227000 228000 23% 32% 22% 35% 81% 80% 80% 81 % 262000 262000 257000 262000 262000 257000 262000 262000 257000 9% 8% 11% 9% 90% 90% 90% 90% 1.1 0.32 1.0 0.21 0.77 0.11 1.0 0.058 95% CI of 0.47 0.078 0.14 0.041 OR QuartZ 2.8 1.3 7.3 1.1 0.74 0.85 1.5 0.85 p Value 0.52 0.77 0.65 0.77 95% CI of 0.29 0.27 0.25 0.27 OR Quart3 . 1.9 2.6 9.4 2.6 OR Quart 4 . 1.4 0.88 1.0 0.72 p Value 0.46 0.82 1.0 0.59 95% C1 Of 0.58 0.28 0.14 0.22 OR Quart4 3.3 2.7 7.3 2.3 Tumor necrosis factor ligand superfamily member 10 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0228 0.0313 0.0228 0.0239 0.0228 0.0313 Average 8.36 2.81 8.36 4.03 8.36 6.36 StdeV 3.2 6.38 3.2 9.01 43.2 14.2 (t—test) 0.40 0.54 0.85 Min 0.0162 0.0162 0.0162 0.0162 0.0162 0.0162 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Max 292 31.9 292 35.0 292 44.8 n (Samp) 95 43 95 39 95 17 n nt) 69 43 69 39 69 17 ——24hrpriortoAKI stage 48hr prior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0313 0.0228 0.0313 4.67 —6—_23 5-61 6-23 13-8 ———29-8 11-2 29-8 18-7 ——— 0-93 0-45 ———0.0162 0.0162 0.0162 0.0162 ———292 35-0 292 44-8 ———223 18 223 9 ———138 18 138 9 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0313 0.0313 0.0313 0.0313 0.0313 0.0313 Average 9.24 2.29 9.24 4.53 9.24 0.671 StdeV 42.8 4.74 2.8 16.5 42.8 2.10 p(t—test) 0.32 0.51 0.46 Min 0.0162 0.0162 0.0162 0.0162 0.0162 0.0162 Max 292 16.7 292 98.4 292 7.88 n (Samp) 98 38 98 39 98 14 n (Patient) 67 38 67 39 67 14 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.51 0.49 0.47 0.52 0.44 0.47 0.65 0.70 0.49 SE 0.053 0.086 0.056 0.055 0.073 0.055 0.077 0.099 0.083 p 0.82 0.90 0.54 0.69 0.41 0.55 0.051 0.043 0.94 nCohort 1 95 223 98 95 223 98 95 223 98 nCohort 2 43 12 38 39 18 39 17 9 14 0.0197 0.0247 0.0313 0.0269 77% 88% 78% 79% 21% 53% 54% 47% 0.0162 0.0247 0.0205 0.0197 82% 88% 89% 86% 53% 24% 21% 0.0162 0 0.0162 94% 100% 93% % 0% 10% 0.0317 0.171 0.0363 41% 56% 14% 73% 70% 71% 0.328 3.32 1.53 % 56% 7% 80% 80% 81% 4.64 10.8 7.32 29% 33% 7% 91% 90% 91 % 1.6 1.0 2.2 0_40 95% CI of 0.31 0.24 0.061 0.36 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only OR Quart2 1.6 12 2.6 3.2 3.5 2.6 10 16 13 OR Quart 3 0.76 1.5 0.85 1.0 1.3 0.77 2.8 2.0 3.5 p Value 0.60 0.65 0.78 1.0 0.71 0.63 0.24 0.57 0.14 95% C1 0f 0.28 0.25 0.28 0.34 0.33 0.26 0.50 0.18 0.65 OR Quart3 2.1 9.5 2.6 3.0 5.1 2.3 16 23 19 OR 1.1 1.6 1.7 1.3 1.6 1.4 4.3 5.4 1.0 p Value 0.87 0.64 0.30 0.65 0.49 0.55 0.086 0.13 1.0 95% C1 0f 0.41 0.25 0.61 0.45 0.42 0.49 0.81 0.61 0.13 OR Quart4 2.9 9.7 4.8 3.6 5.9 3.8 23 48 7.6 Myeloid differentiation primary response protein MyD88 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.000368 0.000245 0.000368 0.000368 68 57 e 0.00255 0.00199 0.00255 0.000350 0.00255 0.00458 StdeV 0.0181 0.00785 0.0181 9.42E—5 0.0181 0.0138 p(t—test) 0.86 0.46 0.72 Min 0.000224 0.000224 0.000224 0.000224 0.000224 0.000224 Max 0.171 0.0441 0.171 0.000457 0.171 0.0463 n (Samp) 90 33 90 37 90 11 11 (Patient) 63 33 63 37 63 11 “_24hroriortoAKI stage 48hr orior to AKI stage ort1 Cohort 2 Cohort 1 Cohort 2 —0.000368 0.000245 0.000368 0.000224 0.000368 57 _0.00184 0.000291 0.00184 0.000301 0.00184 0.000368 ———0.0129 0.000121 0.0129 0.000122 _—— 0.77 0.80 ———0.000126 0.000224 0.000126 0.000224 ———0.171 0.000457 0.171 0.000457 -—_202 6 202 5 1——_21 6 121 5 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.000332 0.000245 0.000332 0.000368 0.000332 0.000457 Average 0.00450 0.00230 0.00450 0.000348 0.00450 0.00456 StdeV 0.0265 0.00850 0.0265 9.37E—5 0.0265 0.0138 (t—test) 0.67 0.34 0.99 0.000224 0.000224 0.000224 0.000224 ———0.194 0.000457 0.194 0.0463 -——94 38 94 11 11 (Patient) 58 28 58 38 58 11 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.42 0.40 0.45 0.53 0.36 0.55 0.71 0.60 0.68 SE 0.059 0.10 0.063 0.057 0.12 0.056 0.091 0.14 0.093 0.17 0.35 0.44 0.63 0.26 0.34 0.022 0.47 0.053 nCohort 1 90 202 94 90 202 94 90 202 94 nCohort 2 33 9 28 37 6 38 11 5 11 Cutoff 1 0 0.000224 0 24 26 0.000224 0.000296 0.000224 0.000296 Sens 1 100% 78% 100% 81% 100% 84% 91% 80% 82% 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only Spec 1 0% 24% 0% 21% 0% 43% 24% 50% Cutoff 2 0 0.000126 0 0.000224 0.000126 0.000296 0.000224 0.000296 Sens 2 100% 100% 100% 81% 100% 91% 80% 82% Spec 2 0% 0% 0% 21% 0% 43% 24% 50% Cutoff 3 0 0.000126 0 0 0.000126 0.000296 0.000126 0.000224 Sens 3 100% 100% 100% 100% 100% 91% 100% 91% Spec 3 0% 0% 0% 0% 0% 43% 0% 24% Cutoff4 0.000368 0.000368 0.000368 0.000368 0.000368 0.000368 0.000368 0.000368 Sens 4 18% 11% 18% 32% 33% 64% 60% 55% Spec 4 71% 72% 72% 71% 72% 71% 72% 72% Cutoff 5 0.000457 0.000457 0.000457 57 0.000457 0.000457 0.000457 0.000457 Sens 5 6% 0% 7% 0% 0% 9% 0% 9% Spec 5 96% 96% 95% 96% 96% 96% 96% 95% Cutoff 6 0.000457 0.000457 0.000457 0.000457 0.000457 0.000457 0.000457 0.000457 Sens 6 6% 0% 7% 0% 0% 9% 0% 9% Spec 6 96% 96% 95% 96% 96% 96% 96% 95% OR Quart 2 1.5 0 1.9 1.5 0 0 0.98 1.0 p Value 0.52 na 0.32 0.46 na na 0.99 1.0 95% C1 Of 0.42 na 0.54 0.51 na na 0.060 0.059 OR Quart2 5.4 na 6.6 4.5 na na 16 17 OR Quart 32.5 6.6 1.8 1.3 0 11 0.98 3.3 p Value 0.14 0.085 0.35 0.63 na 0.029 0.99 0.32 95% C1 0f 0.73 0.77 0.52 0.44 na 1.3 0.060 0.32 OR Quart3 8.4 57 6.3 3.9 na 99 16 34 OR 3.0 2.1 1.6 0.96 2.1 2.0 2.0 7.1 p Value 0.075 0.55 0.48 0.94 0.41 0.58 0.58 0.079 95% C1 0f 0.90 0.18 0.44 0.31 0.36 0.17 0.18 0.80 OR Quart4 10 24 5.7 3.0 12 24 23 64 Table 6: Comparison of marker levels in EDTA samples collected from Cohort 1 (patients that did not progress beyond RIFLE stage 0 or R) and in EDTA samples ted from subjects at 0, 24 hours, and 48 hours prior to reaching stage I or F in Cohort 2.

Heat shock 70 kDa protein 1 sCr or UO 24hr prior to AKI stage ‘ 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 934 928 ———1680 967 ———2210 860 _—— 0-44 0——_288 0-288 ———10700 1970 -—_113 6 11 nt) 92 9 92 6 U0 only 24hr prior to AKI stage 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 934 840 934 336 Average 1650 957 1650 817 StdeV 2190 694 2190 870 p(t—test) 0 35 0.40 UO only 24hr prior to AKI stage 8hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Min 0.288 16.7 0.288 0.288 Max 10700 2280 10700 1970 n (Samp) 99 9 99 5 11 (Patient) 77 9 77 5 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.46 nd 0.47 0.44 nd 0.39 SE 0.10 nd 0.10 0.12 nd 0.14 p 0.73 nd 0.75 0.66 nd 0.44 nCohort 1 113 nd 99 113 nd 99 nCohort 2 9 nd 9 6 nd 5 Cutoff 1 705 nd 664 252 nd 252 Sens 1 78% nd 78% 83% nd 80% Spec 1 44% nd 44% 23% nd 25% Cutoff 2 114 nd 114 252 nd 252 Sens 2 89% nd 89% 83% nd 80% Spec 2 15% nd 16% 23% nd 25% Cutoff 3 4.58 nd 4.58 0 nd 0 Sens 3 100% nd 100% 100% nd 100% Spec 3 6% nd 7% 0% nd 0% Cutoff 4 1620 nd 1610 1620 nd 1610 Sens 4 11% nd 11% 33% nd 20% Spec4 71% nd 71% 71% nd 71% Cutoff 5 2930 nd 2930 2930 nd 2930 Sens 5 0% nd 0% 0% nd 0% Spec5 81% nd 81% 81% nd 81% Cutoff 6 3970 nd 4330 3970 nd 4330 Sens 6 0% nd 0% 0% nd 0% Spec 6 90% nd 91% 90% nd 91% OR Quart 2 3.3 nd 3.2 2.1 nd >2.2 p Value 0.31 nd 0.32 0.56 nd <0.54 95% CI of 0.33 nd 0.32 0.18 nd >0.18 OR Quart2 34 nd 33 24 nd na OR Quart 3 3.2 nd 3.2 1.0 nd >2.2 p Value 0.32 nd 0.32 1.0 nd <0.54 95% CI of 0.32 nd 0.32 0.060 nd >0.18 OR Quart3 33 nd 33 17 nd na OR Quart42.1 nd 2.1 2.1 nd >1.0 p Value 0.54 nd 0.56 0.54 nd <0.98 95% C1 0f 0.18 nd 0.18 0.18 nd >0.062 OR Quart4 25 nd 24 25 nd na Insulin-like growth factor 1 receptor sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0484 0.0572 0.0484 0.0619 0.0484 0.0426 Average 0.346 2.67 0.346 0.938 0.346 1.38 StdeV 2.22 6.87 2.22 3.58 2.22 5.00 (t—test) 0.017 0.32 0.13 Min 9.84E—5 0.0144 9.84E—5 11 9.84E—5 0.000211 Max 21.0 18.2 21.0 14.8 21.0 19.4 n(Samp) 183 7 183 17 183 15 11 (Patient) 122 7 122 17 122 15 n_24hroriortoAKI stage 48hr orior to AKI stage ort1 Cohort 2 Cohort 1 Cohort 2 ———0.0498 7.45 0.0498 0.0596 0——_3OO 7-45 0-300 4-90 2——_Ol 10-4 2-01 9-70 _—— 3-9E-6 9-6E-5 ———9.84E—5 0.0742 9.84E—5 0.0214 ———21-0 14-8 21-0 19-4 -——222 2 222 4 ———145 2 145 4 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0498 0.0572 0.0498 0.0572 0.0498 0.0449 Average 0.393 0.0892 0.393 0.0668 0.393 0.102 Stdev 2.37 0.0767 2.37 0.0525 2.37 0.149 p(t—test) 0.80 0.57 0.67 Min 0.000208 0.0390 0.000208 0.000211 0.000208 0.000211 Max 21.0 0.204 21.0 0.192 21.0 0.543 n (Samp) 159 159 17 159 12 11 (Patient) 102 102 17 102 12 0hr orior to AKI stage 24hr orior to AKI stage 48hr orior to AKI stage sCr or UO sCr on1 UO on1 sCr or UO sCr on1 UO on1 sCr or UO sCr on1 UO on1 AUC 0.65 0.65 0.62 0.60 0.85 0.54 0.54 0.59 0.52 SE 0.11 0.17 0.15 0.075 0.17 0.075 0.079 0.15 0.088 o 0.19 0.38 0.42 0.17 0.038 0.61 0.58 0.55 0.80 nCohort 1 183 222 159 183 222 159 183 222 159 nCohort 2 7 3 4 17 2 17 15 4 12 0.0373 0.0219 0.0390 0.0219 71% 73% 75% 75% A 0% 25% 41% 23% 0.0253 0.0212 0.0212 0.0212 82% 93% 100% 92% % 21% 20% 18% 9 0.00497 0.0212 0.0212 0.0212 94% 93% 100% 92% 21% 20% 18% 0.0692 0.0699 0.0729 A 2% 0.0839 0.134 0.72 95% CI of 0.28 OR Quart2 6.4 OR Quart 3 0.31 p Value 0.32 95% CI of 0.031 OR Quart3 3_1 WO 43310 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only OR Quart43.1 2.0 >1.0 3.3 >1.0 1.8 1.2 0.98 1.3 p Value 0.34 0.58 <1.0 0.16 <0.99 0.46 0.75 0.99 0.72 95% C1 Of 0.31 0.18 >0.060 0.63 >0.062 0.39 0.32 0.060 0.28 OR Quart4 31 23 na 17 na 7.8 5.0 16 6.4 Neural cell adhesion molecule 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 184000 178000 184000 185000 184000 156000 Average 189000 187000 189000 191000 189000 158000 StdeV 70300 63200 70300 93000 70300 51300 p(t—test) 0.90 0.91 0.060 Min 791 93200 791 190 791 49200 Max 520000 316000 520000 506000 520000 280000 11 (Samp) 285 16 285 28 285 19 11 (Patient) 163 16 163 28 163 19 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———181000 232000 181000 175000 ———184000 295000 184000 190000 ———68800 135000 68800 53400 _—— 5-0E-4 0-86 ———190 160000 190 140000 ———520000 506000 520000 280000 -—l—356 5 356 5 ——_197 5 197 5 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 183000 172000 183000 177000 183000 156000 Average 188000 168000 188000 169000 188000 155000 StdeV 72400 51800 72400 65000 72400 47600 st) 0.32 0.19 0.058 Min 791 93200 791 190 791 49200 Max 520000 282000 520000 331000 520000 230000 11 (Samp) 261 13 261 26 261 17 11 (Patient) 143 13 143 26 143 17 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.49 0.73 0.41 0.48 0.79 0.43 0.36 0.51 0.36 SE 0.075 0.15 0.085 0.058 0.12 0.061 0.070 0.13 0.074 0.92 0.12 0.29 0.79 0.015 0.25 0.041 0.91 0.052 nCohort 1 285 356 261 285 356 261 285 356 261 nCohort 2 16 4 13 28 5 26 19 5 17 Cutoff 1 152000 230000 133000 158000 230000 130000 139000 166000 144000 Sens 1 75% 75% 77% 71% 80% 73% 74% 80% 71% SP601 30% 81% 21% 32% 81% 19% 21% 41% 26% Cutoff 2 133000 140000 121000 125000 230000 121000 107000 166000 107000 Sens 2 81% 100% 85% 82% 80% 81% 84% 80% 82% Spec 2 19% 24% 14% 14% 81% 14% 8% 41% 9% Cutoff 3 95600 140000 95600 91800 160000 91800 91800 140000 91800 2012/052298 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only Sens 3 94% 100% 92% 93% 100% 95% 100% 94% Spec 3 6% 24% 6% 5% 37% 5% 24% 5% Cutoff 4 214000 207000 214000 214000 207000 214000 207000 214000 Sens 4 25% 75% 8% 29% 80% 11% 20% 12% Spec 4 70% 71% 70% 70% 71% 70% 71% 70% Cutoff 5 233000 228000 233000 233000 228000 233000 228000 233000 Sens 5 19% 75% 8% 14% 80% 5% 20% 0% Spec 5 80% 80% 80% 80% 80% 80% 80% 80% Cutoff 6 266000 262000 265000 266000 262000 266000 262000 265000 Sens 6 12% 25% 8% 11% 40% 5% 20% 0% Spec 6 90% 90% 90% 90% 90% 90% 90% 90% OR Quart 20.75 0 3.1 1.0 >1.0 2.1 2.0 1.5 p Value 0.71 na 0.33 0.98 <0.99 0.41 0.57 0.64 95% C1 Of 0.16 na 0.32 0.34 >0.062 0.37 0.18 0.25 OR Quart2 3.5 na 31 3.0 na 12 23 9.5 OR Quart 3 1.3 0 5.3 0.86 >0 3.8 1.0 3.8 p Value 0.72 na 0.13 0.79 <na 0.11 1.0 0.11 95% C1 Of 0.33 na 0.60 0.27 >na 0.75 0.062 0.76 OR Quart3 5.0 na 47 2.7 na 19 16 19 OR Quart 4 1.0 3.1 4.2 1.2 >4.1 3.2 0.99 2.7 p Value 0.98 0.34 0.20 0.77 <0.21 0.17 0.99 0.25 95% C1 Of 0.24 0.31 0.46 0.40 >0.45 0.62 0.061 0.50 OR Quart4 4.2 30 39 3.4 na 16 16 14 Myeloid differentiation primary response protein MyD88 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 68 0.000245 0.000368 0.000368 0.000368 0.000368 Average 0.00279 0.000236 0.00279 0.000326 0.00279 0.000351 StdeV 0.0186 1.14E—5 0.0186 9.54E—5 0.0186 0.000109 p(t—test) 0.68 0.59 0.70 Min 0.000126 0.000224 0.000126 0.000224 0.000126 0.000224 Max 0.194 45 0.194 0.000457 0.194 0.000457 11 (Samp) 203 9 203 17 203 9 11 (Patient) 120 9 120 17 120 9 1 stage 48hr orior to AKI stage Cohort 2 Cohort 1 Cohort 2 nd 0.000368 0.000340 nd 0.00235 0.000340 nd 0.0169 0.000165 nd 0.87 nd 0.000126 0.000224 nd 0.194 0.000457 nd 246 2 nd 142 2 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.000368 0.000368 0.000368 07 0296 0.000326 0.00296 0.000337 193 9.54E—5 0.0193 0.000108 _—— 0-57 0-70 Min 0.000126 0.000224 0.000126 0.000224 0.000126 0.000224 WO 43310 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Max 0.194 0.000245 0.194 0.000457 0.194 0.000457 11 (Samp) 189 9 189 17 189 8 11 (Patient) 106 9 106 17 106 8 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.24 nd 0.25 0.47 nd 0.48 0.56 0.48 0.54 SE 0.095 nd 0.096 0.074 nd 0.074 0.10 0.21 0.11 p 0.0060 nd 0.0098 0.73 nd 0.82 0.54 0.94 0.74 nCohort 1 203 nd 189 203 nd 189 203 246 189 nCohort 2 9 nd 9 17 nd 17 9 2 8 26 0.000126 0.000224 0_000224 76% 89% 100% 88% 24% 23% 0% 24% 0.000126 0.000126 0.000126 0_000224 100% 89% 100% 88% 1% 23% 0% 24% 0.000126 26 0.000126 O_000126 100% 100% 100% 100% 1% 0% 0% 1% 0.000368 0.000368 0.000368 68 24% 44% 50% 38% 71% 71% 73% 71% 0.000457 0.000457 0.000457 0_000457 0% 0% 0% 0% 95% 96% 96% 95% 0.000457 0.000457 0.000457 0_000457 0% 0% 0% 0% 95% 96% 96% 95% 1.3 4.2 0 3.1 0.70 0.20 na 0.33 95% CI of 0.33 0.46 na 0.31 OR QuartZ 5.2 39 na 31 0 0 1.0 p Value na na 1.0 95% CI of na na 0.061 OR Quart3 na na 16 OR Quart 4 . 4.2 1.0 3.1 p Value 0_34 95% CI of . 0.46 0.061 0.31 OR Quart4 39 16 31 Table 7: Comparison of marker levels in EDTA samples collected within 12 hours of reaching stage R from Cohort 1 (patients that reached, but did not progress beyond, RIFLE stage R) and from Cohort 2 (patients that reached RIFLE stage I or F).

Insulin-like growth factor 1 receptor sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0447 0.0717 nd nd 0.0478 0.0804 Average 0.574 0.103 nd nd 0.707 0.0835 StdeV 3.27 0.114 nd nd 3.71 0.0515 WO 43310 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 p(t—test) 0.62 nd nd 0.62 Min 0.000208 0.0214 nd nd 0.000208 0.0214 Max 20.5 0.432 nd nd 21.0 0.192 n (Samp) 39 12 nd nd 32 9 11 (Patient) 39 12 nd nd 32 9 At Enrollment sCr or UO sCr only UO only AUC 0.66 nd 0.71 SE 0.095 nd 0.11 p 0.088 nd 0.047 nCohort 1 39 nd 32 nCohort 2 12 nd 9 Cutoff 1 0.0331 nd 0.0545 Sens 1 75% nd 78% Spec 1 31% nd 59% Cutoff 2 0.0292 nd 0.0214 Sens 2 83% nd 89% Spec 2 28% nd 25% Cutoff 3 0.0214 nd 0.0179 Sens 3 92% nd 100% Spec 3 26% nd 19% Cutoff 4 0.0608 nd 0.0608 Sens 4 58% nd 67% Spec 4 72% nd 72% Cutoff 5 0.0692 nd 0.0668 Sens 5 50% nd 67% Spec 5 82% nd 81% Cutoff 6 0.0945 nd 0.0839 Sens 6 33% nd 44% Spec 6 92% nd 91% OR Quart 2 0.91 nd 0 p Value 0.93 nd na 95% CI of 0.11 nd na OR Quart2 7.7 nd na OR Quart 3 0.91 nd 1.0 p Value 0.93 nd 1.0 95% CI of 0.11 nd 0.11 OR Quart3 7.7 nd 8.9 OR Quart 4 4.3 nd 3.3 p Value 0.13 nd 0.23 95% CI of 0.66 nd 0.47 OR Quart4 28 nd 23 Tumor necrosis factor ligand superfamily member 10 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0315 0.0228 nd nd 0.0315 0.0228 Average 6.86 1.36 nd nd 2.72 1.74 StdeV 27.8 5.65 nd nd 5.07 6.41 (t—test) 0.41 nd nd 0.58 Min 0.0162 0.0162 nd nd 0.0162 0.0162 Max 172 24.0 nd nd 16.7 24.0 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 11 (Patient) 38 18 nd nd 32 14 At Enrollment sCr or UO sCr only UO only AUC 0.28 nd 0.29 SE 0.078 nd 0.088 p 0.0054 nd 0.017 nCohort 1 38 nd 32 nCohort 2 18 nd 14 Cutoff1 0.0197 nd 0.0197 Sens 1 72% nd 71% Spec 1 18% nd 16% Cutoff 2 0 nd 0 Sens 2 100% nd 100% Spec 2 0% nd 0% Cutoff 3 0 nd 0 Sens 3 100% nd 100% Spec 3 0% nd 0% Cutoff 4 0.601 nd 0.444 Sens 4 6% nd 7% Spec 4 71% nd 72% Cutoff 5 6.98 nd 6.98 Sens 5 6% nd 7% Spec 5 82% nd 81% Cutoff 6 13.4 nd 10.8 Sens 6 6% nd 7% Spec 6 92% nd 91% OR Quart 2 2.2 nd 0.50 p Value 0.55 nd 0.59 95% CI of 0.17 nd 0.039 OR QuartZ 27 nd 6.4 OR Quart 3 17 nd 5.0 p Value 0.015 nd 0.096 95% CI of 1.8 nd 0.75 OR Quart3 170 nd 33 OR Quart 4 13 nd 4.2 p Value 0.028 nd 0.15 95% CI of 1.3 nd 0.61 OR Quart4 130 nd 29 Table 8: Comparison of the maximum marker levels in EDTA samples collected from Cohort 1 (patients that did not ss beyond RIFLE stage 0) and the maximum values in EDTA samples collected from subjects between enrollment and 0, 24 hours, and 48 hours prior to reaching stage F in Cohort 2.

Heat shock 70 kDa n 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 618 2280 618 2280 Average 1400 2650 1400 2650 Stdev 2030 2030 2030 2030 p(t—test) 0.30 0.30 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Min 0.288 840 0.288 840 Max 10000 4840 10000 4840 n (Samp) 53 3 53 3 11 nt) 53 3 53 3 UO only 0hr prior to AKI stage ——1560 —1410 1560 —1930 1020 10000 2280 0hr prior to AKI stage 24hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only AUC 0.77 nd 0.66 0.77 nd SE 0.16 nd 0.22 0.16 nd p 0.093 nd 0.46 0.093 nd nCohort 1 53 nd 44 53 nd nCohort 2 3 nd 2 3 nd Cutoff 1 837 nd 837 837 nd Sens 1 100% nd 100% 100% nd Spec 1 57% nd 55% 57% nd Cutoff 2 837 nd 837 837 nd Sens 2 100% nd 100% 100% nd Spec 2 57% nd 55% 57% nd Cutoff 3 837 nd 837 837 nd Sens 3 100% nd 100% 100% nd Spec 3 57% nd 55% 57% nd Cutoff 4 1370 nd 1370 1370 nd Sens 4 67% nd 50% 67% nd Spec 4 72% nd 70% 72% nd Cutoff 5 2700 nd 2860 2700 nd Sens 5 33% nd 0% 33% nd Spec 5 81% nd 82% 81% nd Cutoff 6 3540 nd 3630 3540 nd Sens 6 33% nd 0% 33% nd Spec6 91% nd 91% 91% nd OR Quart 2 >0 nd >0 >0 nd p Value <na nd <na <na nd 95% C1 Of >na nd >na >na nd OR Quart2 na nd na na nd OR Quart3>1.1 nd >1.1 >1.1 nd p Value <0.96 nd <0.95 <0.96 nd 95% CI of >0.061 nd >0.060 >0.061 nd OR Quart3 na nd na na nd OR Quart 4 >23 nd >10 >23 nd p Value <0.51 nd <1.0 <0.51 nd 95% C1 Of >0.19 nd >0.055 >0.19 nd OR Quart4 na nd na na nd Neural cell adhesion molecule 1 —_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———184000 172000 184000 167000 1———88000 177000 188000 165000 ——_79000 44400 79000 20800 _—— 0-69 0-57 ———1370 111000 1370 140000 ———520000 245000 520000 187000 -—_88 8 88 4 ——_88 8 88 4 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 181000 177000 181000 177000 181000 167000 Average 187000 188000 187000 181000 187000 165000 Stdev 75100 9800 75100 38000 75100 23700 p(t—test) 0.98 0.88 0.61 Min 190 140000 190 140000 190 140000 Max 520000 256000 520000 230000 520000 187000 11 (Samp) 164 164 4 164 3 11 nt) 164 164 4 164 3 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———180000 162000 180000 158000 ———187000 166000 187000 158000 00 45100 85300 18300 _—— 0-56 0-56 ———1080 111000 1080 140000 ———520000 245000 520000 176000 -—_81 6 81 3 ——_81 6 81 3 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.47 0.50 0.41 0.47 0.48 0.41 0.39 0.38 0.36 SE 0.11 0.15 0.13 0.11 0.15 0.13 0.15 0.17 0.18 p 0.80 0.99 0.47 0.75 0.92 0.47 0.48 0.49 0.43 nCohort 1 88 164 81 88 164 81 88 164 81 nCohort 2 8 4 6 8 4 6 4 3 3 158000 165000 139000 158000 165000 139000 158000 139000 139000 83% 75% 100% 100% % 36% 22% 25% 139000 139000 139000 139000 139000 139000 139000 139000 139000 83% 100% 100% 100% % 24% 22% 25% 107000 139000 107000 107000 139000 107000 139000 139000 139000 100% 100% 100% 100% 12% 24% 22% 25% 216000 217000 214000 216000 217000 214000 216000 217000 214000 17% 0% 0% 0% 70% 70% 70% 70% Cutoff 5 227000 230000 227000 227000 230000 227000 227000 230000 227000 Sens 5 25% 25% 17% 25% 0% 17% 0% 0% 0% Spec 5 81% 80% 80% 81% 80% 80% 81% 80% 80% 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only Cutoff 6 272000 272000 258000 272000 272000 272000 272000 258000 Sens 6 0% 0% 0% 0% 0% 0% 0% 0% Spec 6 91% 90% 90% 91% 90% 91% 90% 90% OR Quart 2 0.48 1.0 0 0.48 1.0 >10 >10 >0 p Value 0.56 1.0 na 0.56 1.0 <0.98 <0.99 <na 95% C1 Of 0.040 0.060 na 0.040 0.060 >0.062 >0.062 >na OR Quart2 5.7 17 na 5.7 17 na na na OR Quart 3 1.6 1.0 4.7 1.6 1.0 >22 >10 >22 p Value 0.64 1.0 0.19 0.64 1.0 <0.53 <0.99 <0.53 95% C1 Of 0.24 0.060 0.48 0.24 0.060 >0.18 >0.062 >0.19 OR Quart3 10 17 46 10 17 na na na OR Quart 4 1.0 1.0 1.0 1.0 1.0 >10 >10 >10 p Value 1.0 1.0 0.97 1.0 1.0 <0.98 <0.97 <0.97 95% C1 Of 0.13 0.060 0.061 0.13 0.060 >0.062 >0.064 >0.061 OR Quart4 7.7 17 18 7.7 17 na na na Tumor necrosis factor ligand superfamily member 10 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0228 0.0271 0.0228 0.0271 0.0228 0.0228 Average 11.3 3.14 11.3 3.14 11.3 2.39 StdeV 50.4 7.16 50.4 7.16 50.4 5.88 p(t—test) 0.58 0.58 0.64 Min 0.0162 0.0162 0.0162 0.0162 0.0162 0.0162 Max 292 20.9 292 20.9 292 15.7 n (Samp) 69 12 69 12 69 7 11 (Patient) 69 12 69 12 69 7 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0313 0.0228 0.0313 0.0228 9—_00 2-64 9-00 5-25 6 6-40 37-6 9-06 _—— 0-68 0-86 ———0.0162 0.0162 0.0162 0.0162 ———292 15-7 292 15-7 -—_138 6 138 3 ——_138 6 138 3 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ———0.0313 0.0271 0.0313 0.0228 ———13-0 2-74 13-O O-173 ———51-4 7-33 51-4 0-367 _—— 0-58 0-55 ———0.0162 0.0162 0.0162 0.0162 ———292 20-9 292 0921 -—_67 8 67 6 11 (Patient) 67 8 67 8 67 6 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.50 0.37 0.44 0.50 0.37 0.44 0.48 0.41 0.35 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only SE 0.091 0.12 0.11 0.091 0.12 0.11 0.12 0.18 0.13 p 0.96 0.30 0.59 0.96 0.30 0.59 0.85 0.60 0.25 nCohort 1 69 138 67 69 138 67 69 138 67 nCohort 2 12 6 8 12 6 8 7 3 6 1 0.0197 0.0205 0.0197 0.0197 0.0205 0.0197 0.0197 0 0.0197 Sens 1 92% 83% 88% 92% 83% 88% 86% 100% 83% Spec 1 17% 14% 12% 17% 14% 12% 17% 0% 12% Cutoff 2 0.0197 0.0205 0.0197 0.0197 0.0205 0.0197 0.0197 0 0.0197 Sens 2 92% 83% 88% 92% 83% 88% 86% 100% 83% Spec 2 17% 14% 12% 17% 14% 12% 17% 0% 12% Cutoff 3 0.0197 0 0 0.0197 0 0 0 0 0 Sens 3 92% 100% 100% 92% 100% 100% 100% 100% 100% Spec 3 17% 0% 0% 17% 0% 0% 0% 0% 0% Cutoff4 0.0392 0.921 0.0591 0.0392 0.921 0.0591 0.0392 0.921 0.0591 Sens 4 25% 17% 25% 25% 17% 25% 29% 33% 17% Spec 4 71% 70% 70% 71% 70% 70% 71% 70% 70% Cutoff 5 2.12 3.82 3.20 2.12 3.82 3.20 2.12 3.82 3.20 Sens 5 17% 17% 12% 17% 17% 12% 14% 33% 0% Spec5 81% 80% 81% 81% 80% 81% 81% 80% 81% Cutoff 6 5.31 15.7 23.0 5.31 15.7 23.0 5.31 15.7 23.0 Sens 6 17% 0% 0% 17% 0% 0% 14% 0% 0% Spec6 91% 91% 91% 91% 91% 91% 91% 91% 91% OR Quart 2 6.3 0 2.1 6.3 0 2.1 0.47 0 >24 p Value 0.11 na 0.55 0.11 na 0.55 0.55 na <0.50 95% C1 Of 0.67 na 0.18 0.67 na 0.18 0.039 na >0.20 OR Quart2 60 na 26 60 na 26 5.7 na na OR Quart 3 3.4 4.4 1.0 3.4 4.4 1.0 1.6 1.0 >0 p Value 0.31 0.20 1.0 0.31 0.20 1.0 0.63 0.98 <na 95% C1 Of 0.32 0.46 0.058 0.32 0.46 0.058 0.23 0.062 >na OR Quart3 35 41 17 35 41 17 11 17 na OR Quart43.2 1.0 5.1 3.2 1.0 5.1 0.47 1.0 >5.4 p Value 0.34 1.0 0.16 0.34 1.0 0.16 0.55 0.98 <0.15 95% C1 Of 0.30 0.060 0.52 0.30 0.060 0.52 0.039 0.062 >0.55 OR Quart4 33 17 51 33 17 51 5.7 17 na Table 9: Comparison of marker levels in urine samples collected from Cohort 1 nts that did not progress beyond RIFLE stage 0, R, or I) and in urine samples collected from Cohort 2 (subjects who progress to RIFLE stage F) at 0, 24 hours, and 48 hours prior to the subject reaching RIFLE stage I.

Stromelysin-leetalloproteinase inhibitor 2 complex sCr or UO Median Average StdeV . (t—te st) —— sCr only 24hr prior to AKI stage Cohort 1 Cohort 2 Median 0.487 10.9 Average 171 181 StdeV 1290 303 st) 0.99 Min 0.237 0.487 Max 13900 530 n (Samp) 118 3 11 (Patient) 91 3 UO only 24hr prior to AKI stage ohort 1 ohort 2 Median .237 .487 Average 90 3.8 tdeV 430 19 (t—test) .83 .237 .487 3900 67 24hr prior to AKI stage sCr or UO sCr only UO only AUC 0.71 0.81 0.73 SE 0.11 0.15 0.13 p 0.063 0.046 0.081 nCohort 1 113 118 96 nCohort 2 7 3 5 Cutoff1 0.237 0.237 0.237 Sens 1 100% 100% 100% Spec 1 45% 43% 52% Cutoff 2 0.237 0.237 0.237 Sens 2 100% 100% 100% Spec 2 45% 43% 52% Cutoff 3 0.237 0.237 0.237 Sens 3 100% 100% 100% Spec 3 45% 43% 52% Cutoff 4 0.487 0.487 0.487 Sens 4 29% 67% 20% Spec 4 82% 82% 82% Cutoff 5 0.487 0.487 0.487 Sens 5 29% 67% 20% Spec 5 82% 82% 82% Cutoff 6 123 154 118 Sens 6 14% 33% 20% Spec 6 90% 91% 91% OR Quart 2 >60 >10 >0 p Value <0.11 <0.98 <na 95% CI of >066 >0.062 >na OR Quart2 na na na OR Quart 3 >0 >0 >48 p Value <na <na <O.18 95% CI of >na >na >O.49 OR Quart3 na na na OR Quart4>2.1 >21 >10 p Value <O.54 <O.56 <1.0 24hr prior to AKI stage sCr or UO sCr only UO only 95% CI of >018 >0.18 >0.059 OR Quart4 na na na Heat shock 70 kDa protein 1 sCr or UO 24hr prior to AKI stage Cohort 1 Cohort 2 Median 277 1420 Average 581 2850 Stdev 1 1 00 4 1 0 st) 2.0E—4 Min 0.297 250 Max 7800 1 1 800 n (Samp) 11 1 6 11 (Patient) 86 6 WWHHOWHHOohort 25 10440W5\0 UO only 24hr prior to AKI stage Cohort 1 Cohort 2 Median 267 934 Average 617 3480 Stdev 1170 5560 p(t—test) 3.5E—4 Min 0.297 250 Max 7800 11800 n (Samp) 96 11 (Patient) 74 24hr rior to AKI stage sCr or UO sCr only UO only 0.83 0.92 0.77 0.10 0.11 0.14 0.0018 1.9E—4 0.055 11 1 1 15 96 6 3 4 529 1040 529 83% 100% 75% 70% 89% 70% 529 1040 246 83% 100% 100% 70% 89% 49% 246 1040 246 100% 100% 100% 48% 89% 49% 24hr prior to AKI stage sCr or UO sCr only UO only Cutoff 4 529 596 574 Sens 4 83% 100% 50% Spec 4 70% 70% 71% Cutoff 5 770 782 782 Sens 5 67% 100% 50% Spec 5 80% 80% 80% Cutoff 6 1040 1320 1340 Sens 6 67% 67% 25% Spec 6 90% 91% 91% OR Quart 2>1.0 >0 >10 p Value <0.98 <na <0.98 95% C1 of >0.062 >na >0.062 OR Quart2 na na na OR Quart 3 >10 >0 >10 p Value <0.98 <na <0.98 95% C1 of >0.062 >na >0.062 OR Quart3 na na na OR Quart 4 >45 >32 >22 p Value <0.19 <0.32 <0.54 95% CI of >047 >0.32 >0.18 OR Quart4 na na na Insulin-like growth factor 1 receptor sCr or UO 24hr prior to AKI stage Cohort 1 Cohort 2 Median 0.0103 0.0103 Average 0.0227 0.0647 StdeV 0.0655 0.132 p(t—test) 0.13 Min 0.000123 2 Max 0.679 0.365 n (Samp) 112 7 11 (Patient) 88 7 n24hr orior to AKI stage UO only 24hr prior to AKI stage Cohort 1 Cohort 2 11 (Patient) 76 5 24hr prior to AKI stage sCr or UO sCr only UO only AUC 0.61 0.57 0.65 SE 0.12 0.17 0.14 p 0.34 0.71 0.28 nCohort 1 112 117 96 nCohort 2 7 3 5 Cutoff 1 0.00862 0.00573 2 Sens 1 86% 100% 100% Spec 1 41% 32% 44% Cutoff 2 0.00862 0.00573 0.00862 Sens 2 86% 100% 100% Spec 2 41 % 32% 44% Cutoff 3 0.00573 0.00573 0.00862 Sens 3 100% 100% 100% Spec 3 33% 32% 44% Cutoff4 0.0197 0.0211 0.0211 Sens 4 29% 0% 40% Spec 4 71% 71% 72% Cutoff 5 0.0292 0.0292 0.0292 Sens 5 14% 0% 20% Spec 5 82% 81% 82% Cutoff 6 0.0423 0.0423 0.0423 Sens 6 14% 0% 20% Spec 6 92% 91% 92% OR Quart 2>4.5 >10 >10 p Value <0.19 <0.98 <0.98 95% CI of >047 >0.062 >0.062 OR Quart2 na na na OR Quart 3 >10 >21 >22 p Value <1.0 <0.54 <0.54 95% CI of >0.060 >0.18 >0.18 OR Quart3 na na na OR Quart 4 >21 >0 >21 p Value <0.56 <na <0.56 95% CI of >018 >na >O.18 OR Quart4 na na na Interstitial collagenase:Metalloproteinase inhibitor 2 complex n24hr orior to AKI stage Cohort 1 Cohort 2 sCr only 24hr prior to AKI stage Cohort 1 Cohort 2 Median 0.233 6.97 Average 149 12.2 StdeV 1470 15.3 p(t—test) 0.87 Min 0.228 0.233 Max 16000 29.5 n (Samp) 118 3 11 (Patient) 91 3 UO only 24hr prior to AKI stage ohort 1 ohort 2 Median .233 .17 Average 73 tdeV 630 29 t) .89 .228 .228 6000 97 24hr prior to AKI stage sCr or UO sCr only UO only AUC 0.66 0.79 0.62 SE 0.12 0.16 0.14 p 0.17 0.072 0.37 nCohort 1 113 118 96 nCohort 2 7 3 5 Cutoff1 0.228 0.228 0 Sens 1 71% 100% 100% Spec 1 38% 39% 0% Cutoff 2 0 0.228 0 Sens 2 100% 100% 100% Spec 2 0% 39% 0% Cutoff 3 0 0.228 0 Sens 3 100% 100% 100% Spec 3 0% 39% 0% Cutoff 4 0.233 0.233 0.233 Sens 4 57% 67% 60% Spec 4 80% 79% 79% Cutoff 5 1.26 1.35 1.26 Sens 5 57% 67% 60% Spec 5 81% 81% 80% Cutoff 6 14.2 18.5 10.7 Sens 6 29% 33% 40% Spec 6 90% 92% 91% OR Quart 2 >21 >0 0 p Value <0.54 <na na 95% C1 Of >0.18 >na na OR Quart2 na na na OR Quart 3 >10 >10 0 p Value <0.98 <0.98 na 95% C1 0f >0.062 >0.062 na OR Quart3 na na na OR Quart4>4.6 >2.1 1.5 p Value <0.18 <0.56 0.67 24hr prior to AKI stage sCr or UO sCr only UO only 95% CI of >0.48 >0.18 0.23 OR Quart4 na na 9.8 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 x sCr or UO 24hr prior to AKI stage Cohort 1 Cohort 2 Median 29.2 295 Average 793 2740 Stdev 2550 5880 p(t—test) 0.081 Min 1 . 15 1 . 15 Max 16000 16000 n (Samp) 108 7 11 (Patient) 86 7 24hr orior to AKI stage O ohort 2 o.) .3 iikl]\1 $86 L 4; \1 00 o [\J kl] O \l \l *,_. U‘ t—‘ >—- O\ M UO only 24hr prior to AKI stage Cohort 1 Cohort 2 Median 28.1 295 Average 868 3670 Stdev 27 10 6930 p(t—test) 0.044 Min 1 . 15 1 . 15 Max 16000 16000 n (Samp) 95 5 11 (Patient) 76 5 24hr rior to AKI stage sCr or UO sCr only UO only 0.70 0.74 0.67 0.11 0.17 0.14 0.081 0.16 0.21 108 113 95 7 3 5 234 164 234 71% 100% 80% 71% 65% 69% 164 164 234 86% 100% 80% 67% 65% 69% 0 164 0 100% 100% 100% 0% 65% 0% 24hr prior to AKI stage sCr or UO sCr only UO only Cutoff 4 227 365 365 Sens 4 71% 67% 40% Spec 4 70% 71% 71% Cutoff 5 595 656 595 Sens 5 43% 0% 40% Spec 5 81% 81% 80% Cutoff 6 1700 1780 1700 Sens 6 29% 0% 40% Spec 6 91% 90% 91% OR Quart 2 0 >0 0 p Value na <na na 95% C1 Of na >na na OR Quart2 na na na ORQuart33.1 >1.0 2.1 p Value 0. 34 <0.98 0.56 95% CI of 0.30 >0.062 0.18 OR Quart3 32 na 25 OR 3.1 >21 2.1 p Value 0. 34 <0.54 0.56 95% CI of 0.30 >0.18 0.18 OR Quart4 32 na 25 Neural cell adhesion molecule 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2720 3990 2720 2690 2720 2100 Average 3340 390 3340 6270 3340 2870 StdeV 2880 3520 2880 11900 2880 2900 p(t—test) 0.093 5.4E—5 0.60 Min 0.234 171 0.234 375 0.234 138 Max 8400 15000 8400 55700 48400 9700 n (Samp) 1261 22 1261 20 1261 10 11 (Patient) 50 22 50 20 450 10 48hr orior to AKI stage Cohort 1 Cohort 2 2780 3900 3450 3740 3260 2410 0.86 0.234 963 55700 6210 1325 4 465 4 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 ——_2840 4560 2840 3280 ———3410 8190 3410 3570 ———2840 12900 2840 3190 _O—— 3-0E-10 0-88 ——_O234 375 0234 346 __—8400 55700 48400 9700 n(Sarnp) 1116 1116 19 1116 7 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 11 (Patient) 364 14 364 19 364 7 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.59 0.42 0.70 0.55 0.58 0.62 0.40 0.57 0.48 SE 0.064 0.11 0.079 0.067 0.15 0.069 0.095 0.15 0.11 p 0.16 0.44 0.010 0.45 0.59 0.084 0.32 0.65 0.88 nCohortl 1261 1325 1116 1261 1325 1116 1261 1325 1116 nCohort 2 22 8 14 20 4 19 10 4 7 2080 1180 2560 1650 74% 70% 75% 71% 34% 16% 46% 24% 1740 957 957 1180 84% 80% 100% 86% 26% 11% 10% 14% 1110 341 957 325 95% 90% 100% 100% 13% 1% 10% 1% A 060 3940 4040 4060 58% 20% 50% 29% 70% 70% 70% 70% 910 4850 4930 4910 A 2% 20% 50% 29% 80% 80% 80% 80% 6470 6440 6520 6470 32% 10% 0% 14% 90% 90% 90% 90% 1.7 1.0 1.0 1.0 0.48 1.0 1.0 1.0 95% CI of 0.40 0.14 0.062 0.14 OR Quart2 . . . 7.1 7.1 16 7.1 . . . 0.33 1.0 0 0 p Value . 0.34 1.0 na na 95% CI of 0.034 0.14 na na OR Quart3 . . 3.2 7.1 na na OR Quart 4 . . . . . 3.4 2.0 2.0 1.5 p Value 0.065 0.42 0.57 0.65 95% CI of 0.93 0.37 0.18 0.25 OR Quart4 . . 13 11 22 9.1 Tumor necrosis factor ligand superfamily member 10 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0285 0.0287 0.0285 0.0387 0.0285 0.0287 Average 2.55 7.89 2.55 9.52 2.55 0.125 StdeV 9.75 24.9 9.75 30.0 9.75 0.289 (t—test) 0.017 0.0029 0.46 Min 0.0110 0.0139 0.0110 0.0110 0.0110 0.0205 Max 159 113 159 134 159 0.894 n (Samp) 1234 21 1234 20 1234 9 11 nt) 56 21 56 20 456 9 “_24hroriortoAKI stage 48hr orior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 sCr only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0285 0.0243 0.0285 1.57 0.0285 0.0287 Average 2.78 1.22 2.78 1.66 2.78 0.0300 Stdev 10.9 3.38 10.9 1.89 10.9 0.00805 p(t—test) 0.69 0.84 0.62 Min 0.0110 0.0139 0.0110 0.0227 0.0110 0.0217 Max 159 9.58 159 3.47 159 0.0410 n (Samp) 1294 8 1294 4 1294 4 11 (Patient) 471 8 71 4 471 4 ——24hrpriortoAKI stage 48hr prior to AKI stage ort1 Cohort 2 Cohort 1 Cohort 2 ———0.0285 0.0410 0.0285 0.0363 —2—_57 15-4 2-57 0-153 —9—_97 38-8 9-97 0-327 ——— 6-1E-7 0-52 ———0.0110 0.0110 0.0110 0.0205 ———159 134 159 0-894 ———1O92 19 1092 7 ———372 19 372 7 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only sCr or UO sCr only UO only AUC 0.57 0.45 0.59 0.61 0.58 0.46 0.49 0.48 SE 0.066 0.11 0.081 0.068 0.15 0.099 0.15 0.11 p 0.30 0.61 0.25 0.12 0.59 0.72 0.95 0.85 nCohort 1 1234 1294 1092 1234 1294 1234 1294 1092 nCohort 2 21 8 14 20 4 9 4 7 Cutoff 1 0.0247 0.0239 0.0285 0.0247 0.0239 0.0217 0.0285 0.0237 Sens 1 76% 88% 71% 70% 75% 78% 75% 71% Spec 1 41% 33% 51% 41% 33% 22% 52% 28% Cutoff 2 0.0239 0.0239 0.0247 0.0217 0.0217 0.0205 0.0205 0.0217 Sens 2 81% 88% 86% 80% 100% 89% 100% 86% Spec 2 37% 33% 40% 22% 22% 19% 18% 21% Cutoff 3 0.0239 0.0110 0.0110 0.0205 0.0217 0.0162 0.0205 0.0162 Sens 3 90% 100% 100% 90% 100% 100% 100% 100% Spec 3 34% 3% 3% 19% 22% 15% 18% 14% Cutoff4 0.0439 0.0410 0.0439 0.0439 0.0410 0.0439 0.0410 0.0439 Sens 4 24% 12% 29% 45% 50% 11% 0% 14% Spec 4 74% 70% 74% 74% 70% 74% 70% 74% Cutoff 5 0.0597 0.0597 0.0597 0.0597 0.0597 0.0597 0.0597 0.0597 Sens 5 24% 12% 29% 45% 50% 11% 0% 14% Spec 5 80% 80% 81% 80% 80% 80% 80% 81% Cutoff 6 5.80 5.86 5.80 5.80 5.86 5.80 5.86 5.80 Sens 6 19% 12% 29% 15% 0% 0% 0% 0% Spec 6 90% 90% 90% 90% 90% 90% 90% 90% OR Quart 2 3.0 1.0 1.00 0.39 1.00 4.0 >3.0 3.0 p Value 0.18 1.00 1.00 0.27 1.00 0.21 <0.34 0.34 95% C1 Of 0.61 0.062 0.14 0.076 0.062 0.45 >0.31 0.31 OR Quart2 15 16 7.1 2.1 16 36 na 29 OR Quart 34.1 5.1 3.0 0.80 0 2.0 >0 1.0 p Value 0.078 0.14 0.18 0.74 na 0.57 <na 1.0 95% C1 Of 0.86 0.59 0.61 0.21 na 0.18 >na 0.062 OR Quart3 19 44 15 3.0 na 22 na 16 OR Quart 4 2.5 1.0 2.0 1.8 2.0 2.0 >1.0 2.0 p Value 0.27 1.00 0.42 0.29 0.57 0.57 <1.00 0.57 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only 95% CI of 0.48 0.062 0.36 0.60 0.18 0.60 0.18 >0.063 0.18 OR Quart4 13 16 11 5.5 22 5.5 22 na 22 Myeloid differentiation primary response protein MyD88 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.000533 0.000146 0.000533 0.000165 Average 0.0162 0.000146 0.0162 0.00319 StdeV 0.0567 2.76E—5 0.0567 0.00825 p(t—test) 0.69 0.52 Min 0.000126 0.000126 0.000126 0.000165 Max 0.671 0.000165 0.671 0.0236 n (Samp) 247 2 247 8 11 (Patient) 141 2 141 8 4hr orior to AKI stage ohort 1 ohort 2 .000533 .000165 .0159 .000288 .0562 .000213 .000126 .000165 .671 .000533 11 (Sam) 52 11 nt) 45 UO only 24hr prior to AKI stage Cohort 1 Cohort 2 Median 0.000533 0.000165 e 0.0141 0.000239 StdeV 0.0390 0.000165 p(t—test) 0.43 Min 0.000126 65 Max 0.371 0.000533 11 (Samp) 233 5 11 (Patient) 128 5 orior to AKI stage orior to AKI stage sCr only sCr or UO sCr only nd 0.38 0.33 nd 0.11 0.17 nd 0.25 0.33 nd 247 252 nd 8 3 nd 0.000126 0.000126 nd 100% 100% nd 11% 10% nd 0.000126 26 nd 100% 100% nd 11% 10% nd 0.000126 0.000126 nd 100% 100% nd 11% 10% 0hr prior to AKI stage 24hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only Cutoff 4 0.00247 nd nd 0.00247 0.00237 0.00616 Sens 4 0% nd nd 12% 0% 0% Spec 4 70% nd nd 70% 70% 71% Cutoff 5 0.0184 nd nd 0.0184 0.0184 0.0190 Sens 5 0% nd nd 12% 0% 0% Spec 5 80% nd nd 80% 81% 80% Cutoff 6 0.0393 nd nd 0.0393 0.0387 0.0387 Sens 6 0% nd nd 0% 0% 0% Spec 6 90% nd nd 90% 90% 90% OR Quart 2 >0 nd nd 2.0 >0 >10 p Value <na nd nd 0.57 <na <0.98 95% C1 Of >na nd nd 0.18 >na >0.063 OR Quart2 na nd nd 23 na na OR Quart 3 >0 nd nd 5.3 >3.1 >0 p Value <na nd nd 0.13 <0.33 <na 95% C1 Of >na nd nd 0.61 >0.32 >na OR Quart3 na nd nd 47 na na OR Quart 4 >21 nd nd 0 >0 >44 p Value <0.55 nd nd na <na <0.19 95% C1 Of >0.19 nd nd na >na >0.47 OR Quart4 na nd nd na na na Table 10: Comparison of marker levels in EDTA samples collected from Cohort 1 (patients that did not progress beyond RIFLE stage 0, R, or I) and in EDTA s collected from Cohort 2 (subjects who progress to RIFLE stage F) at 0, 24 hours, and 48 hours prior to the subject reaching RIFLE stage I.

Heat shock 70 kDa protein 1 24hr prior to AKI stage 24hr prior to AKI stage sCr or UO sCr only UO only AUC 0.64 nd 0.64 SE 0.21 nd 0.21 p 0.51 nd 0.52 nCohort 1 129 nd 1 13 nCohort 2 2 nd 2 Cutoff 1 837 nd 837 Sens 1 100% nd 100% Spec 1 49% nd 49% Cutoff 2 837 nd 837 Sens 2 100% nd 100% Spec 2 49% nd 49% Cutoff 3 837 nd 837 Sens 3 100% nd 100% Spec 3 49% nd 49% Cutoff 4 1560 nd 1560 Sens 4 50% nd 50% Spec 4 71% nd 71% Cutoff 5 2550 nd 2550 Sens 5 0% nd 0% Spec 5 81% nd 81% Cutoff 6 3630 nd 3540 Sens 6 0% nd 0% Spec 6 91% nd 90% OR Quart 2>1.0 nd >1.0 p Value <1.0 nd <10 95% CI of >0.060 nd >0.060 OR Quart2 na nd na OR Quart 3 >0 nd >0 p Value <na nd <na 95% Cl Of >na nd >na OR Quart3 na nd na OR Quart4>1.0 nd >1.0 p Value <1.0 nd <10 95% CI of >0.060 nd >0.060 OR Quart4 na nd na n-like growth factor 1 receptor sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0484 0.0490 0.0484 0.0644 0.0484 0.0214 ———0.521 0.0732 0.521 0.0337 2——_80 0-0681 2-80 0-0410 _—— 0-75 0-7 6 ———9.84E—5 11 9.84E—5 0.000211 ———21-0 0-164 21-0 0-0795 -——229 4 229 3 11 (Patient) 148 2 148 4 148 3 U0 only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median nd nd 0.0520 0.0319 0.0520 0.0108 Average nd nd 0.336 0.0570 0.336 0.0108 StdeV nd nd 2.14 0.0752 2.14 0.0150 (t—test) nd nd 0.80 0.83 Min nd nd 0.000172 0.000211 0.000172 0.000211 UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Max nd nd 21.0 0.164 21.0 0.0214 n (Samp) nd nd 196 4 196 2 11 (Patient) nd nd 124 4 124 2 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.46 nd nd 0.56 nd 0.39 0.33 nd 0.11 SE 0.21 nd nd 0.15 nd 0.15 0.17 nd 0.15 p 0.83 nd nd 0.71 nd 0.47 0.32 nd 0.010 nCohort 1 229 nd nd 229 nd 196 229 nd 196 nCohort 2 2 nd nd 4 nd 1 3 nd 2 0.00767 0.000208 nd 0.000208 100% nd 100% 3% nd 3% 0.00767 0.000208 0.000208 nd 08 100% nd 100% 3% nd 3% 0.00767 0.000208 0.000208 nd 0.000208 100% nd 100% 3% nd 3% 0.0699 nd 0.0769 33% nd 0% 70% nd 70% 0.0888 nd 0.0888 0% nd 0% 81% nd 81 % 0.135 nd 0.135 0% nd 0% 90% nd 90% . >1.0 nd >0 1.0 <0.99 nd <na 95%C1<>f—>na 0R Quartz n— p Value —<na 95% CI of na >na nd >na OR Quart3 n— OR Quart 4 . 2.0 >2.1 nd >2.1 p Value —<0-54 >f—>0-19 OR Quart4 23 na nd na Neural cell adhesion molecule 1 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 181000 111000 181000 166000 181000 162000 Average 186000 154000 186000 177000 186000 163000 StdeV 72800 88700 72800 50000 72800 22700 (t—test) 0.45 0.76 0.52 Min 190 96200 190 125000 190 140000 Max 520000 256000 520000 245000 520000 187000 11 (Samp) 369 3 369 6 369 4 11 (Patient) 201 3 201 6 201 4 WO 43310 sCr only 48hr prior to AKI stage Cohort 1 Cohort 2 Median 181000 154000 Average 186000 154000 StdeV 72400 19300 p(t—test) 0.53 Min 190 140000 Max 520000 167000 11 (Samp) 376 2 11 (Patient) 205 2 ————— ————— 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.35 nd nd 0.47 nd 0.40 0.38 0.32 0.39 SE 0.17 nd nd 0.12 nd 0.14 0.15 0.21 0.21 p 0.39 nd nd 0.79 nd 0.48 0.43 0.40 0.60 nCohort 1 369 nd nd 369 nd 339 369 376 339 nCohort 2 3 nd nd 6 nd 5 4 2 2 Cutoff 1 95600 nd nd 131000 nd 130000 147000 140000 147000 Sens 1 100% nd nd 83% nd 80% 75% 100% 100% Spec 1 7% nd nd 20% nd 22% 28% 24% 30% Cutoff 2 95600 nd nd 131000 nd 130000 140000 140000 147000 Sens 2 100% nd nd 83% nd 80% 100% 100% 100% Spec 2 7% nd nd 20% nd 22% 24% 24% 30% Cutoff 3 95600 nd nd 125000 nd 109000 140000 140000 147000 Sens 3 100% nd nd 100% nd 100% 100% 100% 100% Spec 3 7% nd nd 16% nd 12% 24% 24% 30% Cutoff 4 208000 nd nd 208000 nd 207000 208000 208000 207000 Sens 4 33% nd nd 33% nd 20% 0% 0% 0% Spec 4 70% nd nd 70% nd 70% 70% 70% 70% Cutoff 5 229000 nd nd 229000 nd 228000 229000 229000 228000 Sens 5 33% nd nd 33% nd 20% 0% 0% 0% Spec 5 80% nd nd 80% nd 80% 80% 80% 80% Cutoff 6 268000 nd nd 268000 nd 262000 268000 266000 262000 Sens 6 0% nd nd 0% nd 0% 0% 0% 0% Spec 6 90% nd nd 90% nd 90% 90% 90% 90% OR Quart 2 0 nd nd 0 nd 0 >10 >0 >0 p Value na nd nd na nd na <0.99 <na <na 95% C1 Of na nd nd na nd na >0.063 >na >na OR Quart2 na nd nd na nd na na na na OR Quart 3 0 nd nd 1.0 nd 2.0 >21 >10 >21 p Value na nd nd 1.0 nd 0.57 <0.56 <0.99 <0.55 95% C1 Of na nd nd 0.14 nd 0.18 >0.18 >0.062 >0.18 OR Quart3 na nd nd 7.3 nd 23 na na na OR Quart 4 2.0 nd nd 1.0 nd 2.0 >10 >10 >0 p Value 0.57 nd nd 0.99 nd 0.57 <0.99 <0.99 <na 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only 95% CI of 0.18 nd nd 0.14 nd 0.18 >0.063 >0.063 >na OR Quart4 23 nd nd 7.3 nd 23 na na na Tumor necrosis factor ligand superfamily member 10 sCr or UO 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0313 0.0313 0.0313 0.0271 0.0313 0.0313 e 7.00 1.03 7.00 0.615 7.00 3.95 StdeV 29.0 2.23 29.0 1.44 29.0 7.84 p(t—test) 0.65 0.59 0.83 Min 0.0162 0.0228 0.0162 0.0228 0.0162 0.0162 Max 292 5.02 292 3.56 292 15.7 n (Samp) 290 5 290 6 290 4 11 (Patient) 174 5 174 6 174 4 “_24hroriortoAKI stage 48hr orior to AKI stage ———Cohort1 Cohort 2 Cohort 1 Cohort 2 mm0-0271 nd nd 6——_84 0-0271 nd nd ———28-6 000598 nd nd _—— 0-74 nd nd 0——_0162 0-0228 nd nd ———292 0-0313 nd nd -——300 2 nd nd ———180 2 nd nd UO only 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median nd nd 0.0313 0.0228 0.0313 0.0313 Average nd nd 6.81 0.0262 6.81 0.0313 StdeV nd nd 29.7 0.00463 29.7 0 p(t—test) nd nd 0.61 0.75 Min nd nd 0.0162 0.0228 0.0162 0.0313 Max nd nd 292 0.0313 292 0.0313 n (Samp) nd nd 271 5 271 2 11 (Patient) nd nd 158 5 158 2 orior to AKI stage orior to AKI stage orior to AKI stage sCr only sCr only sCr only 0.40 0.40 nd 0.21 0.21 nd 0.62 0.62 nd 300 300 nd 2 2 nd 0.0205 0.0205 100% 100% nd 23% 23% nd 0.0205 0.0205 nd 100% 100% nd 23% 23% nd 0.0205 0.0205 nd 100% 100% nd 23% 23% nd 0hr prior to AKI stage 24hr prior to AKI stage 48hr prior to AKI stage sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only Cutoff4 0.171 0.0943 nd 0.171 0.0943 0.0700 0.171 nd 0.0700 Sens 4 20% 0% nd 17% 0% 0% 25% nd 0% Spec 4 70% 70% nd 70% 70% 70% 70% nd 70% Cutoff 5 3.61 3.61 nd 3.61 3.61 3.32 3.61 nd 3.32 Sens 5 20% 0% nd 0% 0% 0% 25% nd 0% Spec 5 81% 80% nd 81% 80% 80% 81% nd 80% Cutoff 6 14.0 14.0 nd 14.0 14.0 13.4 14.0 nd 13.4 Sens 6 0% 0% nd 0% 0% 0% 25% nd 0% Spec 6 90% 90% nd 90% 90% 90% 90% nd 90% OR Quart 2 0 >0 nd 0 >0 >0 0 nd >0 p Value na <na nd na <na <na na nd <na 95% C1 Of na >na nd na >na >na na nd >na OR Quart2 na na nd na na na na nd na OR Quart 34.2 >2.1 nd 5.3 >21 >54 2.0 nd >2.1 p Value 0.21 <0.56 nd 0.13 <0.56 <0.13 0.57 nd <0.55 95% C1 Of 0.45 >0.18 nd 0.60 >0.18 >0.61 0.18 nd >0.19 OR Quart3 38 na nd 46 na na 23 nd na OR Quart 4 0 >0 nd 0 >0 >0 1.0 nd >0 p Value na <na nd na <na <na 0.99 nd <na 95% C1 Of na >na nd na >na >na 0.062 nd >na OR Quart4 na na nd na na na 17 nd na Myeloid differentiation primary se protein MyD88 sCr or UO 24hr prior to AKI stage Cohort 1 Cohort 2 Median 0.000368 0.000368 Average 0.00229 0.000350 StdeV 0.0167 0.000118 p(t—test) 0.84 Min 0.000126 0.000224 Max 0.194 0.000457 11 (Samp) 253 3 11 (Patient) 144 3 __-'-I ____ "—nd 24hr prior to AKI stage sCr or UO sCr only UO only Spec 1 0% nd 53% Cutoff 2 26 nd 0.000296 Sens 2 100% nd 100% Spec 2 0% nd 53% Cutoff 3 0.000126 nd 0.000296 Sens 3 100% nd 100% Spec 3 0% nd 53% Cutoff 4 0.000368 nd 0.000368 Sens 4 33% nd 50% Spec 4 73% nd 74% Cutoff 5 0.000457 nd 0.000457 Sens 5 0% nd 0% Spec 5 96% nd 96% Cutoff 6 0.000457 nd 0.000457 Sens 6 0% nd 0% Spec 6 96% nd 96% OR Quart 2 1.0 nd >0 p Value 1.0 nd <na 95% C1 Of 0.061 nd >na OR Quart2 16 nd na OR Quart 3 0 nd >2.1 p Value na nd <0.56 95% CI of na nd >0.18 OR Quart3 na nd na OR Quart 4 1.0 nd >0 p Value 1.0 nd <na 95% C1 Of 0.061 nd >na OR Quart4 16 nd na Table 11: Comparison of marker levels in enroll urine samples collected from Cohort 1 (patients that did not progress beyond RIFLE stage 0 or R within 48hrs) and in enroll urine samples collected from Cohort 2 (subjects reaching RIFLE stage I or F within 48hrs). Enroll samples from ts already at RIFLE stage I or F were ed in Cohort 2.

Stromelysin-leetalloproteinase inhibitor 2 complex sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.487 10.9 0.487 343 0.237 31.8 Average 85.9 135 82.5 295 63.8 151 StdeV 314 197 298 263 303 204 p(t—test) 0.65 0.23 0.44 Min 0.237 0.487 0.237 10.9 0.237 0.487 Max 1930 530 1930 530 1930 530 n (Samp) 9 9 55 3 41 8 11 (Patient) 9 9 55 3 41 8 At Enrollment sCr or UO sCr only UO only AUC 0.79 0.90 0.82 SE 0.094 0.12 0.094 At ment sCr or UO sCr only UO only p 0.0019 7.3E—4 6.2E—4 nCohort 1 49 55 41 nCohort 2 9 3 8 Cutoff1 0.237 3.84 0.237 Sens 1 100% 100% 100% Spec 1 49% 82% 56% Cutoff 2 0.237 3.84 0.237 Sens 2 100% 100% 100% Spec 2 49% 82% 56% Cutoff 3 0.237 3.84 0.237 Sens 3 100% 100% 100% Spec 3 49% 82% 56% Cutoff 4 0.487 0.487 0.487 Sens 4 56% 100% 50% Spec 4 82% 80% 83% Cutoff 5 0.487 0.487 0.487 Sens 5 56% 100% 50% Spec 5 82% 80% 83% Cutoff 6 201 201 85.2 Sens 6 33% 67% 38% Spec 6 92% 91% 90% OR Quart 2 >22 >0 >1.1 p Value <0.55 <na <0.95 95% C1 of >017 >na >0.061 OR Quart2 na na na OR Quart 3 >23 >0 >40 p Value <0.51 <na <0.26 95% CI of >019 >na >0.35 OR Quart3 na na na OR Quart 4 >70 >35 >53 p Value <0.097 <0.30 <0.16 95% CI of >071 >0.32 >0.51 OR Quart4 na na na Heat shock 70 kDa protein 1 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 257 1300 342 1510 225 1090 Average 1 37 3130 690 3320 449 3360 —I—l—1660 3510 484 4460 _—— 0-015 1-0E-4 0——_297 1090 0-297 250 ———11800 7360 1870 11800 -I__51 3 41 7 11 (Patient) 1 6 8 51 3 41 7 At Enrollment sCr or UO sCr only UO only AUC 0.85 0.93 0.83 SE 0.090 0.10 0.099 1.2E—4 4.4E—5 9.2E—4 nCohort 1 46 51 41 nCohort 2 8 3 7 Cutoff 1 755 1020 755 At Enrollment sCr or UO sCr only UO only Sens 1 75% 100% 71% Spec 1 80% 88% 80% Cutoff 2 408 1020 408 Sens 2 88% 100% 86% Spec 2 61% 88% 61% Cutoff 3 225 1020 225 Sens 3 100% 100% 100% Spec 3 50% 88% 51% Cutoff 4 634 660 627 Sens 4 75% 100% 71% Spec 4 72% 71 % 71 % Cutoff 5 755 782 755 Sens 5 75% 100% 71% Spec 5 80% 80% 80% Cutoff 6 1020 1150 1020 Sens 6 62% 67% 57% Spec 6 91% 90% 90% OR Quart2 >1.0 >0 >1.1 p Value <1.0 <na <0.95 95% CI of >0.056 >na >0.061 OR Quart2 na na na OR Quart 3 >24 >0 >24 p Value <0.51 <na <0.50 95% CI of >019 >na >0.19 OR Quart3 na na na OR Quart 4 >72 >35 >60 p Value <0.093 <0.30 <0.14 95% CI of >072 >0.32 >0.56 OR Quart4 na na na Insulin-like growth factor 1 receptor sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 0.0103 0.0197 0.0103 0.0292 0.0245 0.0223 0.0174 0.0664 0.0515 0.0152 0.0233 0.122 0.94 0.018 0 000123 0.00862 0.000123 0.00132 0.0388 0.0976 0.365 At Enrollment sCr or UO sCr only UO only AUC 0.67 0.62 0.72 SE 0.1 1 0.18 0.1 1 0.11 0.49 0.039 nCohort 1 49 55 41 nCohort 2 9 3 8 Cutoff 1 0.00862 0.00454 2 Sens 1 78% 100% 88% Spec 1 41% 33% 46% Cutoff 2 0.00454 0.00454 0.00862 Sens 2 89% 100% 88% At Enrollment sCr or UO sCr only UO only Spec 2 35% 33% 46% Cutoff 3 0.000519 0.00454 0.000519 Sens 3 100% 100% 100% Spec 3 24% 33% 29% Cutoff4 0.0197 0.0211 0.0169 Sens 4 44% 33% 62% Spec 4 71% 71% 71% Cutoff 5 0.0296 0.0339 0.0292 Sens 5 44% 33% 50% Spec 5 82% 80% 80% Cutoff 6 0.0423 0.0436 0.0388 Sens 6 22% 0% 38% Spec 6 92% 91% 90% OR Quart2 3.2 >1.0 >1.1 p Value 0.33 <1.0 <0.95 95% CI of 0.30 >0.057 >0.061 OR Quart2 36 na na OR Quart 3 1.0 >1.1 >4.0 p Value 1.0 <0.96 <0.26 95% CI of 0.056 >0.061 >0.35 OR Quart3 18 na na OR Quart 4 4.7 >10 >53 p Value 0.19 <1.0 <0.16 95% C1 0f 0.46 >0.057 >0.51 OR Quart4 49 na na 72 kDa type IV enase:Metalloproteinase inhibitor 2 complex sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 36.4 527 57.4 527 46.9 561 Average 345 960 853 5570 320 5560 StdeV 585 7200 2700 9040 551 7450 p(t—test) 5.4E—5 0.016 3.4E—5 Min 1.15 1.15 1.15 171 1.15 1.15 Max 2270 16000 16000 16000 2270 16000 n (Samp) 5 9 51 3 40 8 11 (Patient) 5 9 51 3 40 8 At Enrollment sCr or UO sCr only UO only 0.67 0.78 0.68 0.1 1 0.16 0.1 1 0.10 0.081 0.11 45 51 40 9 3 8 158 158 234 78% 100% 75% 64% 61% 72% 0 158 0 100% 100% 100% 0% 61% 0% 0 158 0 100% 100% 100% 0% 61% 0% At Enrollment sCr or UO sCr only UO only Cutoff 4 234 378 189 Sens 4 67% 67% 75% Spec 4 71 % 71 % 70% Cutoff 5 656 660 419 Sens 5 33% 33% 62% Spec 5 80% 80% 80% Cutoff 6 1380 1450 1120 Sens 6 33% 33% 38% Spec 6 91% 90% 90% OR Quart 2 0 >0 0 p Value na <na na 95% CI of na >na na OR Quart2 na na na OR Quart 3 1.6 >2.4 1.0 p Value 0.62 <0.51 1.0 95% CI of 0.23 >0.19 0.12 OR Quart?) 12 na 8.6 OR Quart 4 2.2 >1.0 2.5 p Value 0.42 <1.0 0.35 95% CI of 0.33 >0.056 0.36 OR Quart4 15 na 17 Neural cell adhesion molecule 1 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 2440 3710 2670 4860 2490 3900 Average 3050 5520 3340 7980 3120 5680 StdeV 2340 7260 3480 8950 2140 7560 st) 5.1E—8 3.7E—7 4.7E—7 Min 6.83 138 6.83 171 173 138 Max 22000 55700 55700 31700 15500 55700 n (Samp) 380 91 48 19 297 79 11 (Patient) 380 91 48 19 297 79 At Enrollment sCr or UO sCr onl UO onl AUC 0.65 0.68 0.64 SE 0.034 0.069 0.037 o 1.8E—5 0.011 1.2E—4 nCohort 1 380 448 297 nCohort 2 91 19 79 Cutoff 1 2670 2850 2670 Sens 1 70% 74% 71% Spec 1 54% 55% 53% Cutoff 2 2130 2200 2080 Sens 2 80% 84% 81% Spec 2 42% 42% 39% Cutoff3 1210 1230 1110 Sens 3 90% 95% 91% Spec 3 19% 19% 14% Cutoff 4 3740 3910 3910 Sens 4 49% 53% 49% Spec 4 70% 70% 70% Cutoff 5 4550 4730 4750 At Enrollment sCr or UO sCr only UO only Sens 5 34% 53% 34% Spec 5 80% 80% 80% Cutoff 6 5740 6280 6040 Sens 6 23% 32% 24% Spec 6 90% 90% 90% OR Quart 2 1.3 0.66 1.5 p Value 0.57 0.65 0.30 95% CI of 0.57 0.11 0.68 OR Quart2 2.7 4.0 3.5 OR Quart 3 2.5 1.3 2.6 p Value 0.013 0.71 0.017 95% C1 Of 1.2 0.29 1.2 OR Quart3 5.1 6.1 5.7 OR Quart 4 3.2 3.5 3.2 p Value 0.0010 0.061 0.0030 95% CI of 1.6 0.94 1.5 OR Quart4 6.5 13 6.9 Tumor necrosis factor ligand superfamily member 10 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0257 0.0269 0.0257 0.0271 0.0257 0.0285 Average 2.34 .96 2.69 6.59 2.28 5.68 StdeV 9.11 19.8 11.1 25.2 9.37 21.4 p(t—test) 0.064 0.16 0.040 Min 0.0110 0.0110 0.0110 0.0110 0.0110 0.0139 Max 83.5 134 134 113 83.5 134 n (Samp) 370 89 35 20 291 76 11 nt) 370 89 35 20 291 76 At Enrollment sCr or UO sCr onl UO onl AUC 0.58 0.56 0.58 SE 0.035 0.068 0.038 o 0.015 0.37 0.024 nCohort 1 370 435 291 nCohort 2 89 20 76 Cutoff 1 0.0239 0.0239 0.0239 Sens 1 80% 70% 79% Spec 1 46% 44% 42% Cutoff 2 0.0237 0.0239 0.0237 Sens 2 85% 85% 86% ®%2 %% n% m% Cutoff 3 0.0217 0.0217 0.0227 Sens 3 93% 90% 91% Spec 3 34% 29% 35% Cutoff4 0.0439 0.0410 0.0439 Sens 4 21% 30% 22% Spec 4 74% 70% 75% Cutoff 5 0.0597 0.0597 0.0526 Sens 5 20% 30% 22% Spec 5 82% 82% 81% Cutoff 6 4.27 4.75 3.36 Sens 6 13% 10% 17% At Enrollment sCr or UO sCr only UO only Spec 6 90% 90% 90% OR Quart 2 7.6 4.2 12 p Value 1.5E—5 0.074 1.1E—5 95% CI of 3.0 0.87 3.9 OR Quart2 19 20 35 OR Quart 3 6.4 2.0 7.2 p Value 8.4E—5 0.42 4.6E—4 95% CI of 2.5 0.36 2.4 OR Quart3 16 11 22 OR Quart4 3.6 3.1 4.9 p Value 0.0094 0.17 0.0057 95% CI of 1.4 0.61 1.6 OR Quart4 9.3 16 15 Table 12: Comparison of marker levels in enroll EDTA s ted from Cohort 1 (patients that did not progress beyond RIFLE stage 0 or R within 48hrs) and in enroll EDTA samples collected from Cohort 2 (subjects reaching RIFLE stage I or F within 48hrs). Enroll samples from patients already at stage I or F were included in Cohort 2.

Heat shock 70 kDa protein 1 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 905 1080 nd nd 949 1080 Average 1300 1080 nd nd 1200 1080 StdeV 1610 642 nd nd 1150 642 p(t—test) 0.70 nd nd 0.77 Min .58 261 nd nd 4.58 261 Max 9150 2280 nd nd 4430 2280 n (Samp) 6 9 nd nd 40 9 11 (Patient) 6 9 nd nd 40 9 At Enrollment sCr or UO sCr only UO only AUC 0.56 nd 0.54 SE 0.11 nd 0.11 p 0.60 nd 0.73 nCohort 1 46 nd 40 nCohort 2 9 nd 9 Cutoff 1 705 nd 618 Sens 1 78% nd 78% Spec 1 48% nd 45% Cutoff 2 297 nd 297 Sens 2 89% nd 89% Spec 2 28% nd 28% Cutoff 3 252 nd 252 Sens 3 100% nd 100% Spec 3 24% nd 22% Cutoff 4 1370 nd 1370 Sens 4 33% nd 33% Spec 4 72% nd 70% At Enrollment sCr or UO sCr only UO only Cutoff 5 1970 nd 1970 Sens 5 11% nd 11% Spec 5 80% nd 80% Cutoff 6 3400 nd 3300 Sens 6 0% nd 0% Spec 6 91% nd 90% OR Quart 2 3.3 nd 3.7 p Value 0.33 nd 0.29 95% C1 Of 0.29 nd 0.32 OR QuartZ 36 nd 42 OR Quart 3 3.3 nd 3.7 p Value 0.33 nd 0.29 95% CI of 0.29 nd 0.32 OR Quart3 36 nd 42 OR Quart 4 2.0 nd 2.0 p Value 0.59 nd 0.59 95% CI of 0.16 nd 0.16 0R Q1181rt4 25 nd 25 Insulin-like growth factor 1 receptor sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0458 0.0656 0.0498 0.0283 0.0514 0.0619 Average 0.465 1.16 0.412 3.91 0.540 0.0941 StdeV 2.58 .56 2.38 8.68 2.79 0.133 p(t—test) 0.40 0.013 0.54 Min 0.000208 0.000172 0.000172 0.00927 0.000208 0.000172 Max 20.5 19.4 20.5 19.4 20.5 0.543 n (Samp) 68 18 80 5 58 15 11 (Patient) 68 18 80 5 58 15 At ment sCr or UO sCr onl UO onl AUC 0.57 0.43 0.53 SE 0.078 0.14 0.085 o 0.39 0.62 0.70 nCohort 1 68 80 58 t 2 18 5 15 Cutoff 1 0.0373 0.0134 0.0373 Sens 1 72% 80% 73% Spec 1 41% 12% 36% Cutoff 2 0.0134 0.0134 0.0258 Sens 2 83% 80% 80% Spec 2 12% 12% 26% Cutoff 3 0.000208 0.00497 0.000208 Sens 3 94% 100% 93% Spec 3 3% 9% 2% Cutoff 4 0.0668 0.0766 0.0766 Sens 4 50% 20% 40% Spec 4 71% 70% 71% Cutoff 5 0.0839 0.0839 0.0839 Sens 5 33% 20% 33% Spec 5 84% 80% 83% Cutoff 6 0.139 0.139 0.167 At ment sCr or UO sCr only UO only Sens 6 17% 20% 7% Spec 6 91% 90% 91% OR Quart 2 0.94 1.0 1.4 p Value 0.94 0.97 0.67 95% CI of 0.20 0.061 0.27 OR Quart2 4.4 18 7.5 OR Quart 3 1.0 1.0 1.0 p Value 1.0 0.97 1.0 95% CI of 0.21 0.061 0.17 OR Quart3 4.7 18 5.8 OR Quart 4 1.6 2.2 1.8 p Value 0.53 0.53 0.48 95% CI of 0.38 0.19 0.36 OR Quart4 6.7 26 8.9 Neural cell adhesion molecule 1 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 183000 162000 179000 147000 181000 162000 Average 186000 154000 180000 158000 184000 152000 StdeV 73200 64800 73400 55400 68800 65200 p(t—test) 0.034 0.56 0.036 Min 791 190 190 111000 791 190 Max 94000 331000 94000 230000 461000 331000 11 (Samp) 111 28 134 4 100 26 11 (Patient) 111 28 134 4 100 26 At Enrollment sCr or UO sCr onl UO onl AUC 0.35 0.40 0.35 SE 0.061 0.15 0.064 o 0.018 0.52 0.018 nCohort 1 111 134 100 nCohort 2 28 4 26 Cutoff 1 111000 114000 109000 Sens 1 71% 75% 73% Spec 1 13% 18% 12% Cutoff 2 93300 109000 93300 Sens 2 82% 100% 81% Spec 2 8% 15% 8% Cutoff 3 79400 109000 79400 Sens 3 93% 100% 92% Spec 3 5% 15% 5% Cutoff 4 214000 208000 214000 Sens 4 14% 25% 12% Spec 4 70% 70% 70% Cutoff 5 229000 228000 229000 Sens 5 11% 25% 8% Spec 5 80% 81% 80% Cutoff 6 268000 265000 265000 Sens 6 4% 0% 4% Spec 6 90% 90% 90% OR Quart 2 1.3 0 1.9 p Value 0.72 na 0.43 At Enrollment sCr or UO sCr only UO only 95% CI of 0.32 na 0.40 OR Quart2 5.3 na 8.6 OR Quart 3 2.3 1.0 3.2 p Value 0.21 1.0 0.11 95% CI of 0.62 0.060 0.77 OR Quart3 8.5 17 14 OR Quart 4 3.7 2.1 4.6 p Value 0.042 0.55 0.033 95%C10f 1.0 0.18 1.1 OR Quart4 13 25 19 Tumor is factor ligand superfamily member 10 sCr or UO sCr only UO only Cohort 1 Cohort 2 Cohort 1 Cohort 2 Cohort 1 Cohort 2 Median 0.0247 0.0276 0.0247 0.0313 0.0313 0.0276 Average 10.2 2.74 8.59 7.70 11.1 1.20 StdeV 28.2 9.26 25.9 16.7 29.3 3.76 p(t—test) 0.19 0.93 0.12 Min 0.0162 0.0162 0.0162 0.0162 0.0162 0.0162 Max 172 4.8 172 44.8 172 15.7 n (Samp) 85 26 103 7 78 22 11 (Patient) 85 26 103 7 78 22 At Enrollment sCr or UO sCr onl UO onl AUC 0.47 0.53 0.46 SE 0.065 0.11 0.071 o 0.70 0.82 0.60 nCohort 1 85 103 78 nCohort 2 26 7 22 Cutoffl 0.0197 0.0197 0.0197 Sens 1 81% 86% 82% Spec 1 21% 21% 21% Cutoff 2 0.0197 0.0197 0.0197 Sens 2 81% 86% 82% Spec 2 21% 21% 21% Cutoff 3 0 0 0.0162 Sens 3 100% 100% 91% Spec 3 0% 0% 9% Cutoff4 0.0317 0.0317 0.0700 Sens 4 19% 29% 18% Spec 4 71% 73% 71% Cutoff 5 2.48 1.46 4.64 Sens 5 12% 29% 9% Spec 5 80% 81% 81% Cutoff 6 33.1 25.8 43.5 Sens 6 4% 14% 0% Spec 6 91% 90% 91% OR Quart 2 2.8 2.0 2.9 p Value 0.12 0.58 0.17 95% C1 0f 0.76 0.17 0.64 OR QuartZ 11 23 13 OR Quart 3 2.4 2.1 1.8 p Value 0.20 0.56 0.44 At Enrollment sCr or UO sCr only UO only 95% CI of 0.63 0.18 0.39 OR Quart3 9.2 24 8.7 OR Quart 4 1.4 2.0 2.9 p Value 0.67 0.58 0.17 95% CI of 0.32 0.17 0.64 OR Quart4 5.7 23 13 While the invention has been bed and exemplified in sufficient detail for those skilled in this art to make and use it, various alternatives, cations, and improvements should be apparent t departing from the spirit and scope of the invention. The examples provided herein are representative of preferred embodiments, are exemplary, and are not intended as limitations on the scope of the invention.

Modifications therein and other uses will occur to those skilled in the art. These modifications are encompassed within the spirit of the ion and are defined by the scope of the claims.

It will be readily nt to a person skilled in the art that varying substitutions and modifications may be made to the invention disclosed herein without departing from the scope and spirit of the invention.

All patents and publications mentioned in the specification are indicative of the levels of those of ordinary skill in the art to which the ion ns. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by nce.

The invention illustratively described herein suitably may be practiced in the absence of any element or elements, limitation or limitations which is not specifically disclosed herein. Thus, for example, in each instance herein any of the terms “comprising”, “consisting essentially of” and “consisting of” may be replaced with either of the other two terms. The terms and expressions which have been employed are used as terms of description and not of limitation, and there is no intention that in the use of such terms and expressions of excluding any equivalents of the features shown and described or portions thereof, but it is recognized that various modifications are possible within the scope of the invention claimed. Thus, it should be tood that although the present invention has been specifically disclosed by preferred embodiments and optional features, modification and variation of the concepts herein disclosed may be resorted to by those 2012/052298 skilled in the art, and that such modifications and variations are considered to be within the scope of this invention as defined by the appended Claims.

Other embodiments are set forth within the following Claims.

We

Claims (124)

claim:

1. A method for evaluating renal status in a subject ex vivo, comprising: performing one or more assays configured to detect one or more biomarkers in a body fluid sample obtained usly from the subject to provide an assay result, wherein at least one of the markers is 72 kDa type IV enase:Metalloproteinase inhibitor 2 complex; and correlating an assay result(s) to the renal status of the subject.

2. A method according to claim 1, wherein said correlation step comprises correlating the assay result(s) to one or more of risk stratification, diagnosis, g, prognosis, classifying and monitoring of the renal status of the subject.

3. A method according to claim 1 or claim 2, wherein said correlating step comprises assigning a likelihood of one or more future changes in renal status to the subject based on the assay result(s).

4. A method according any one of claims 1 to 3, wherein said one or more future changes in renal status comprise one or more of a future injury to renal on, future reduced renal on, future improvement in renal on, and future acute renal failure (ARF).

5. A method according to any one of claims 1 to 4, further comprising one or more assays to detect at least 1, 2, 3, or 4 of: a measured concentration of Heat shock 70 kDa protein 1, a measured concentration of Alphaantitrypsin Neutrophil elastase complex, a ed concentration of Stromelysin-1:Metalloproteinase inhibitor 2 complex, a measured concentration of Insulin-like growth factor 1 receptor, a measured concentration of Myeloid differentiation primary response protein MyD88, a ed concentration of Neuronal cell adhesion molecule, and a measured concentration of Tumor necrosis factor ligand superfamily member 10.

6. A method according to any one of claims 1 to 5, wherein a plurality of assay results are combined using a function that converts the ity of assay results into a single composite result.

7. A method according to any one of claims 1 to 6, wherein said one or more future changes in renal status comprise a clinical outcome related to a renal injury ed by the subject.

8. A method according to any one of claims 1 to 7, wherein the likelihood of one or more future changes in renal status is that an event of interest is more or less likely to occur within 30 days of the time at which the body fluid sample was obtained from the subject.

9. A method according to claim 8, wherein the likelihood of one or more future changes in renal status is that an event of st is more or less likely to occur within a period selected from the group consisting of 21 days, 14 days, 7 days, 5 days, 96 hours, 72 hours, 48 hours, 36 hours, 24 hours, and 12 hours.

10. A method according to any one of claims 1 to 9, wherein the subject is selected for evaluation of renal status based on the pre-existence in the subject of one or more known risk factors for prerenal, intrinsic renal, or postrenal ARF.

11. A method according to any one of claims 1 to 10, wherein the subject is selected for evaluation of renal status based on an existing diagnosis of one or more of congestive heart e, ampsia, sia, diabetes mellitus, hypertension, coronary artery e, proteinuria, renal insufficiency, glomerular filtration below the normal range, cirrhosis, serum creatinine above the normal range, sepsis, injury to renal function, reduced renal function, or ARF, or based on undergoing or having one major vascular surgery, ry artery bypass, or other cardiac surgery, or based on exposure to NSAIDs, cyclosporines, tacrolimus, aminoglycosides, foscarnet, ethylene glycol, hemoglobin, bin, ifosfamide, heavy metals, methotrexate, radiopaque contrast agents, or streptozotocin.

12. A method according to any one of claims 1 to 11, wherein said correlating step comprises ing a diagnosis of the occurrence or nonoccurrence of one or more of an injury to renal function, reduced renal function, or ARF to the subject based on the assay result(s).

13. A method according to any one of claims 1 to 12, wherein said correlating step comprises assessing whether or not renal function is improving or worsening in a subject who has suffered from an injury to renal function, reduced renal function, or ARF based on the assay result(s).

14. A method according to any one of claims 1 to 13, wherein said method is a method of diagnosing the occurrence or urrence of an injury to renal function in said subject.

15. A method according to any one of claims 1 to 13, wherein said method is a method of diagnosing the occurrence or urrence of reduced renal function in said subject.

16. A method according to any one of claims 1 to 13, wherein said method is a method of diagnosing the occurrence or nonoccurrence of acute renal failure in said subject.

17. A method according to any one of claims 1 to 13, wherein said method is a method of diagnosing the occurrence or nonoccurrence of a need for renal replacement therapy in said subject.

18. A method according to any one of claims 1 to 13, wherein said method is a method of sing the occurrence or nonoccurrence of a need for renal transplantation in said subject.

19. A method according to any one of claims 1 to 13, wherein said method is a method of assigning a risk of the future occurrence or nonoccurrence of an injury to renal function in said subject.

20. A method according to any one of claims 1 to 13, wherein said method is a method of assigning a risk of the future occurrence or nonoccurrence of reduced renal function in said t.

21. A method according to any one of claims 1 to 13, wherein said method is a method of assigning a risk of the future occurrence or nonoccurrence of acute renal failure in said subject.

22. A method ing to any one of claims 1 to 13, wherein said method is a method of assigning a risk of the future occurrence or nonoccurrence of a need for renal replacement y in said subject.

23. A method according to any one of claims 1 to 13, wherein said method is a method of assigning a risk of the future occurrence or urrence of a need for renal transplantation in said subject.

24. A method according to any one of claims 1 to 23, wherein said one or more future changes in renal status comprise one or more of a future injury to renal function, future reduced renal function, future improvement in renal function, and future acute renal e (ARF) within 72 hours of the time at which the body fluid sample was obtained.

25. A method according to any one of claims 1 to 24, wherein said one or more future changes in renal status comprise one or more of a future injury to renal function, future reduced renal function, future improvement in renal function, and future acute renal failure (ARF) within 48 hours of the time at which the body fluid sample was obtained.

26. A method according to any one of claims 1 to 25, n said one or more future changes in renal status comprise one or more of a future injury to renal on, future reduced renal function, future improvement in renal function, and future acute renal failure (ARF) within 24 hours of the time at which the body fluid sample was obtained.

27. A method according to any one of claims 1 to 26, wherein the subject is in RIFLE stage 0 or R.

28. A method according to claim 27, wherein the t is in RIFLE stage 0, and said ating step comprises assigning a likelihood that the subject will reach RIFLE stage R, I or F within 72 hours.

29. A method according to claim 28, wherein the subject is in RIFLE stage 0, and said correlating step comprises assigning a hood that the subject will reach RIFLE stage I or F within 72 hours.

30. A method according to claim 28, wherein the subject is in RIFLE stage 0, and said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 72 hours.

31. A method according to claim 27, wherein the subject is in RIFLE stage 0 or R, and said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 72 hours.

32. A method according to claim 31, wherein the subject is in RIFLE stage 0 or R, and said correlating step comprises assigning a likelihood that the t will reach RIFLE stage F within 72 hours.

33. A method according to claim 27, wherein the subject is in RIFLE stage R, and said ating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 72 hours.

34. A method according to claim 33, n the subject is in RIFLE stage R, and said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 72 hours.

35. A method ing to any one of claims 1 to 26, wherein the subject is in RIFLE stage 0, R, or I, and said correlating step comprises assigning a hood that the t will reach RIFLE stage F within 72 hours.

36. A method according to claim 35, wherein the subject is in RIFLE stage I, and said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 72 hours.

37. A method according to claim 28, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage R, I or F within 48 hours.

38. A method according to claim 29, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 48 hours.

39. A method according to claim 30, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 48 hours.

40. A method according to claim 31, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 48 hours.

41. A method according to claim 32, wherein said correlating step comprises assigning a hood that the subject will reach RIFLE stage F within 48 hours.

42. A method according to claim 33, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 48 hours.

43. A method according to claim 34, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 48 hours.

44. A method ing to claim 35, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 48 hours.

45. A method ing to claim 36, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 48 hours.

46. A method according to claim 28, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage R, I or F within 24 hours.

47. A method according to claim 29, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 24 hours.

48. A method according to claim 30, wherein said correlating step comprises ing a likelihood that the subject will reach RIFLE stage F within 24 hours.

49. A method according to claim 31, wherein said correlating step comprises assigning a likelihood that the t will reach RIFLE stage I or F within 24 hours.

50. A method according to claim 32, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 24 hours.

51. A method according to claim 33, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage I or F within 24 hours.

52. A method according to claim 34, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 24 hours.

53. A method according to claim 35, wherein said correlating step comprises assigning a likelihood that the subject will reach RIFLE stage F within 24 hours.

54. A method according to claim 36, wherein said ating step ses ing a likelihood that the subject will reach RIFLE stage F within 24 hours.

55. A method according to any one of claims 1 to 26, wherein the subject is not in acute renal e.

56. A method according to any one of claims 1 to 26, wherein the t has not experienced a 1.5-fold or greater increase in serum creatinine over a ne value determined prior to the time at which the body fluid sample was obtained.

57. A method according to any one of claims 1 to 26, wherein the subject has a urine output of at least 0.5 ml/kg/hr over the 6 hours preceding the time at which the body fluid sample was obtained.

58. A method according to any one of claims 1 to 26, wherein the t has not experienced an increase of 0.3 mg/dL or greater in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained.

59. A method according to any one of claims 1 to 26, wherein the subject (i) has not experienced a 1.5-fold or greater increase in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained, (ii) has a urine output of at least 0.5 ml/kg/hr over the 6 hours preceding the time at which the body fluid sample was obtained, and (iii) has not experienced an se of 0.3 mg/dL or greater in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained.

60. A method according to any one of claims 1 to 26, wherein the subject (i) has not experienced a ld or greater increase in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained, (ii) has a urine output of at least 0.5 ml/kg/hr over the 12 hours preceding the time at which the body fluid sample was obtained, and (iii) has not experienced an se of 0.3 mg/dL or r in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained.

61. A method according to any one of claims 1 to 26, wherein said correlating step comprises assigning one or more of: a likelihood that within 72 hours the t will (i) experience a 1.5-fold or greater increase in serum creatinine (ii) have a urine output of less than 0.5 ml/kg/hr over a 6 hour period, or (iii) experience an increase of 0.3 mg/dL or greater in serum creatinine.

62. A method according to any one of claims 1 to 61, wherein said correlating step comprises assigning one or more of: a likelihood that within 48 hours the subject will (i) experience a 1.5-fold or greater se in serum creatinine (ii) have a urine output of less than 0.5 ml/kg/hr over a 6 hour period, or (iii) experience an increase of 0.3 mg/dL or greater in serum creatinine.

63. A method according to any one of claims 1 to 61, wherein said correlating step comprises assigning one or more of: a hood that within 24 hours the subject will (i) experience a 1.5-fold or greater increase in serum creatinine (ii) have a urine output of less than 0.5 hr over a 6 hour period, or (iii) experience an increase of 0.3 mg/dL or greater in serum creatinine.

64. A method according to claim 61, wherein said ating step comprises assigning a likelihood that within 72 hours the subject will experience a 1.5-fold or greater increase in serum creatinine.

65. A method according to claim 61, wherein said correlating step comprises assigning a likelihood that within 72 hours the subject will have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

66. A method according to claim 61, wherein said correlating step comprises assigning a likelihood that within 72 hours the subject will experience an increase of 0.3 mg/dL or greater in serum creatinine.

67. A method according to claim 61, wherein said correlating step ses ing a likelihood that within 48 hours the subject will experience a 1.5-fold or greater increase in serum nine.

68. A method according to claim 61, wherein said correlating step ses assigning a likelihood that within 48 hours the subject will have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

69. A method according to claim 61, wherein said correlating step comprises assigning a likelihood that within 48 hours the subject will experience an increase of 0.3 mg/dL or r in serum creatinine.

70. A method according to claim 61, wherein said correlating step comprises ing a likelihood that within 24 hours the subject will experience a 1.5-fold or greater increase in serum creatinine.

71. A method according to claim 61, wherein said correlating step comprises assigning a likelihood that within 24 hours the subject will have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

72. A method according to claim 61, wherein said correlating step comprises assigning a hood that within 24 hours the subject will experience an increase of 0.3 mg/dL or greater in serum creatinine.

73. A method according to any one of claims 1 to 26, wherein the subject has not experienced a 2-fold or greater increase in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained.

74. A method according to any one of claims 1 to 26, n the subject has a urine output of at least 0.5 ml/kg/hr over the 12 hours preceding the time at which the body fluid sample was obtained.

75. A method according to any one of claims 1 to 26, wherein the subject (i) has not experienced a 2-fold or greater increase in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained, (ii) has a urine output of at least 0.5 ml/kg/hr over the 2 hours ing the time at which the body fluid sample was obtained, and (iii) has not experienced an increase of 0.3 mg/dL or greater in serum creatinine over a baseline value ined prior to the time at which the body fluid sample was obtained.

76. A method according to any one of claims 1 to 26, wherein the subject has not experienced a 3-fold or r increase in serum creatinine over a baseline value determined prior to the time at which the body fluid sample was obtained.

77. A method according to any one of claims 1 to 26, wherein the subject has a urine output of at least 0.3 ml/kg/hr over the 24 hours preceding the time at which the body fluid sample was obtained, or anuria over the 12 hours preceding the time at which the body fluid sample was ed.

78. A method according to any one of claims 1 to 26, wherein the subject (i) has not experienced a 3-fold or greater increase in serum creatinine over a baseline value ined prior to the time at which the body fluid sample was obtained, (ii) has a urine output of at least 0.3 ml/kg/hr over the 24 hours preceding the time at which the body fluid sample was obtained, or anuria over the 12 hours preceding the time at which the body fluid sample was obtained, and (iii) has not experienced an increase of 0.3 mg/dL or greater in serum creatinine over a ne value determined prior to the time at which the body fluid sample was obtained.

79. A method according to any one of claims 1 to 26, wherein said correlating step comprises ing one or more of: a hood that within 72 hours the subject will (i) experience a 2-fold or greater increase in serum creatinine (ii) have a urine output of less than 0.5 ml/kg/hr over a 12 hour period, or (iii) experience an increase of 0.3 mg/dL or r in serum creatinine.

80. A method according to claim 79, wherein said correlating step comprises assigning one or more of: a likelihood that within 48 hours the subject will (i) experience a 2-fold or greater increase in serum creatinine (ii) have a urine output of less than 0.5 ml/kg/hr over a 6 hour period, or (iii) experience an increase of 0.3 mg/dL or greater in serum nine.

81. A method according to claim 79, wherein said correlating step comprises assigning one or more of: a likelihood that within 24 hours the subject will (i) experience a 2-fold or greater increase in serum creatinine, or (ii) have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

82. A method according to claim 79, wherein said correlating step comprises assigning a likelihood that within 72 hours the subject will experience a 2-fold or greater se in serum creatinine.

83. A method according to claim 79, wherein said correlating step comprises assigning a likelihood that within 72 hours the t will have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

84. A method according to claim 79, wherein said ating step comprises assigning a likelihood that within 48 hours the t will experience a 2-fold or greater increase in serum creatinine.

85. A method according to claim 79, wherein said correlating step comprises assigning a likelihood that within 48 hours the subject will have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

86. A method according to claim 79, wherein said ating step comprises assigning a likelihood that within 24 hours the subject will experience a 2-fold or greater increase in serum creatinine.

87. A method according to claim 79, wherein said correlating step comprises assigning a likelihood that within 24 hours the subject will have a urine output of less than 0.5 ml/kg/hr over a 6 hour period.

88. A method according to any one of claims 1 to 26, wherein said correlating step comprises assigning one or more of: a likelihood that within 72 hours the subject will (i) experience a 3-fold or greater increase in serum creatinine, or (ii) have a urine output of less than 0.3 ml/kg/hr over a 24 hour period or anuria over a 12 hour period.

89. A method according to claim 88, wherein said correlating step comprises ing one or more of: a likelihood that within 48 hours the subject will (i) experience a 3-fold or greater increase in serum creatinine, or (ii) have a urine output of less than 0.3 ml/kg/hr over a 24 hour period or anuria over a 12 hour period.

90. A method according to claim 88, n said correlating step comprises assigning one or more of: a likelihood that within 24 hours the subject will (i) experience a 3-fold or greater increase in serum creatinine, or (ii) have a urine output of less than 0.3 ml/kg/hr over a 24 hour period or anuria over a 12 hour period.

91. A method ing to claim 88, wherein said ating step comprises assigning a likelihood that within 72 hours the subject will experience a 3-fold or greater se in serum creatinine.

92. A method according to claim 88, wherein said correlating step comprises assigning a likelihood that within 72 hours the subject will have a urine output of less than 0.3 ml/kg/hr over a 24 hour period or anuria over a 12 hour period.

93. A method according to claim 88, wherein said correlating step comprises ing a hood that within 48 hours the subject will experience a 3-fold or greater increase in serum creatinine.

94. A method according to claim 88, n said correlating step comprises assigning a likelihood that within 48 hours the subject will have a urine output of less than 0.3 ml/kg/hr over a 24 hour period or anuria over a 12 hour period.

95. A method according to claim 88, wherein said correlating step comprises assigning a likelihood that within 24 hours the subject will ence a 3-fold or greater increase in serum creatinine.

96. A method according to claim 88, wherein said correlating step comprises assigning a likelihood that within 24 hours the subject will have a urine output of less than 0.3 ml/kg/hr over a 24 hour period or anuria over a 12 hour period.

97. A method according to any one of claims 1 to 96, n the body fluid sample is a urine sample.

98. A method according to any one of claims 1 to 97, wherein said method comprises performing assays that further se detecting one, two, three, or more of Heat shock 70 kDa protein 1, Alphaantitrypsin phil elastase complex, Stromelysin- 1:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 receptor, d differentiation y response protein MyD88, Neuronal cell adhesion molecule, and Tumor necrosis factor ligand superfamily member 10.

99. A kit, comprising: reagents when used to te renal status ex vivo by performing one or more assays on a body fluid sample obtained previously from a subject configured to detect 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 x.

100. A kit according to claim 99, additionally comprising one or more assays configured to detect one, two, three or more of Heat shock 70 kDa protein 1, Alpha antitrypsin Neutrophil elastase complex, Stromelysin-1:Metalloproteinase inhibitor 2 complex, Insulin-like growth factor 1 receptor, Myeloid differentiation primary response protein MyD88, Neuronal cell adhesion molecule, and Tumor necrosis factor ligand superfamily member 10.

101. A kit according to claim 99 or 100, wherein said reagents comprise one or more binding reagents, each of which specifically binds one of said biomarkers.

102. A kit according to any one of claims 99 to 101, wherein said reagents are ned in a single assay device.

103. A kit according to any one of claims 99 to 102, wherein at least one of said assays is ured as a sandwich g assay.

104. A kit according to any one of claims 99 to 103, wherein at least one of said assays is configured as a competitive binding assay.

105. A method for evaluating biomarker levels in a body fluid sample, comprising: a urine sample obtained previously from a subject selected for evaluation based on a determination that the subject is at risk of a future or current acute renal injury; and performing a plurality of analyte binding assays configured to detect one or more biomarkers, wherein at least one biomarker is 72 kDa type IV collagenase:Metalloproteinase tor 2 complex by ucing the urine sample obtained usly from the subject into an assay ment which (i) contacts a plurality of reagents which ically bind for detection of one or more biomarkers within the urine sample, wherein at least one biomarker detected is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex and (ii) generates one or more assay results indicative of binding of the one or more biomarkers assayed to a respective specific binding reagent in the plurality of reagents.

106. A method according to claim 105, wherein the t is selected for evaluation based on a determination that the subject is in need of risk stratification, diagnosis, staging, prognosis, classifying or monitoring of the renal status of the subject.

107. A method according to claim 105 or claim 106, wherein the subject is selected for evaluation based on a determination that the subject is at risk of a future acute renal injury.

108. A method according to any one of claims 105 to 107, wherein the t is selected for evaluation based on a ination that the subject is at risk of a future injury to renal function, future reduced renal function, future improvement in renal function, and future acute renal failure (ARF).

109. A method according to any one of claims 105 to 108, n the subject is selected for evaluation based on a determination that the subject is at risk of a future acute renal injury within 30 days of the time at which the urine sample was obtained from the subject.

110. A method according to claim 109, n the t is selected for evaluation based on a determination that the subject is at risk of a future acute renal injury within a period selected from the group consisting of 21 days, 14 days, 7 days, 5 days, 96 hours, 72 hours, 48 hours, 36 hours, 24 hours, and 12 hours.

111. A method according to any one of claims 105 to 110, wherein the subject is selected based on the pre-existence in the subject of one or more known risk factors for prerenal, intrinsic renal, or postrenal ARF.

112. A method according to any one of claims 105 to 111, wherein the subject is selected for evaluation based on an existing diagnosis of one or more of tive heart failure, preeclampsia, eclampsia, diabetes mellitus, hypertension, coronary artery e, proteinuria, renal insufficiency, glomerular filtration below the normal range, cirrhosis, serum creatinine above the normal range, sepsis, injury to renal function, reduced renal function, or ARF, or based on undergoing or having undergone major vascular surgery, coronary artery bypass, or other c surgery, or based on exposure to NSAIDs, cyclosporines, tacrolimus, aminoglycosides, net, ethylene glycol, hemoglobin, myoglobin, mide, heavy metals, methotrexate, radiopaque contrast , or streptozotocin.

113. A method according to any one of claims 105 to 112, wherein the plurality of analyte binding assays are immunoassays performed by (i) introducing the urine sample into an assay device comprising a plurality of antibodies, at least one of which binds to the one or more kers assayed, and (ii) generating an assay result indicative of binding of the one or more biomarkers to its respective antibody.

114. A method according to claim 105, wherein the subject is selected for evaluation based on a ination that the subject is at risk of one or more future changes in renal status selected from the group consisting of a future injury to renal function, future reduced renal on, future improvement in renal function, and future acute renal failure (ARF) within 72 hours of the time at which the urine sample was obtained.

115. A method according to claim 114, wherein the subject is selected for tion based on a determination that the subject is at risk of one or more future changes in renal status selected from the group consisting of a future injury to renal function, future reduced renal function, future improvement in renal function, and future acute renal failure (ARF) within 48 hours of the time at which the urine sample was obtained.

116. A method according to claim 115, wherein the subject is ed for evaluation based on a determination that the subject is at risk of one or more future changes in renal status selected from the group consisting of a future injury to renal function, future reduced renal function, future ement in renal function, and future acute renal failure (ARF) within 24 hours of the time at which the urine sample was obtained.

117. A method according to any one of claims 105 to 116, wherein the subject is in RIFLE stage 0 or R.

118. A method according to any one of claims 105 to 117, wherein the subject is in RIFLE stage 0, R, or I.

119. A method according to claim 105, wherein at least one assay result is a measured concentration of 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex.

120. A system when used to evaluate renal status ex vivo, comprising: a reagent(s) which specifically bind for detection of one or more biomarkers, wherein at least one biomarker is 72 kDa type IV collagenase:Metalloproteinase inhibitor 2 complex; an assay instrument ured to receive a urine sample and contact the t(s) with the urine sample and to generate one or more assay results indicative of binding of the one or more biomarkers assayed to a respective specific binding reagent in the reagent(s).

121. A system according to claim 120, wherein the assay instrument comprises an assay device and an assay device reader.

122. A system according to claim 120 or claim 121, wherein the reagents se a plurality of antibodies, at least one of which binds to each of the biomarkers which are assayed.

123. A system according to claim 122, wherein the plurality of dies are immobilized at a plurality of predetermined locations within the assay , wherein the assay device is ured to receive the urine sample such that the urine sample contacts the plurality of predetermined locations, and wherein the assay device reader interrogates the plurality of predetermined locations to generate the assay results.

124. A system according to any one of claims 120 to 123, wherein the reagent(s) are for performing one or more assays, wherein at at least one assay detects 72 kDa type IV enase:Metalloproteinase inhibitor 2 complex.