Cardiac surgery-associated acute kidney injury (CSA-AKI) remains one of the most frequent
and serious complications following cardiac surgery. Despite advances in surgical techniques and perioperative care, the incidence of CSA-AKI remains high and is associated with increased morbidity, mortality, and long-term renal dysfunction. Traditional diagnostic methods based on serum creatinine and urine output detect kidney injury relatively late, limiting the opportunity for early therapeutic intervention. Recent advances in biomarker discovery have opened new possibilities for early detection and risk stratification of patients at risk of CSA-AKI. Biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and the cell cycle arrest markers TIMP-2 and IGFBP7 have demonstrated promising predictive capabilities. This article reviews the pathophysiology of CSA-AKI and discusses emerging strategies for biomarkerguided personalized prevention and management. The integration of biomarker-based risk stratification with targeted preventive interventions may significantly improve patient outcomes and reduce the burden of postoperative kidney injury.
