Acute Kidney Injury Biomarkers in Perioperative Care: A Scoping Review of Clinical Implementation

<b>Background</b>: Acute kidney injury (AKI) remains one of the most common perioperative complications, carrying substantial mortality and healthcare burden. Traditional diagnostic criteria relying on serum creatinine and urine output are limited by delayed detection and inability to characterize the underlying injury phenotype. This scoping review examined the current state of novel AKI biomarker research in perioperative care, evaluated their clinical implementation, and identified knowledge gaps. <b>Methods</b>: A systematical search was performed for studies investigating novel AKI biomarkers in surgical settings. Biomarkers were categorized as functional, stress, or damage markers. Data extraction focused on diagnostic performance, clinical outcomes, regulatory approval status, and implementation barriers. A narrative synthesis was organized by biomarker category and thematic areas. <b>Results</b>: Several biomarkers demonstrated superior early diagnostic performance compared to traditional ones, including PENK or CCL-14, showing promising accuracy for AKI detection and outcome prediction. TIMP-2*IGFBP-7 and NGAL achieved regulatory approval, and biomarker-guided KDIGO care bundles significantly reduced AKI incidence in surgical populations. However, substantial heterogeneity exists in assays, cutoff values, and clinical validation across different clinical settings. <b>Conclusions</b>: Novel AKI biomarkers offer a promise for early detection and risk stratification in perioperative care, yet widespread clinical adoption requires addressing standardization challenges, establishing cost-effectiveness, and validating implementation strategies.