Translating Acute and Drug-Induced Kidney Injury Biomarkers to Point-of-Care Diagnosis in Resource-Limited Settings

Acute kidney injury (AKI) is associated with mortality and chronic kidney disease, but conventional monitoring may detect it late. Drug-induced kidney injury (DIKI) is a potentially preventable cause of AKI and an important concern in people living with Human Immunodeficiency Virus (HIV) who receive potentially nephrotoxic medications. Serum creatinine and urine output describe functional changes, but do not directly measure tubular injury. Candidate biomarkers provide complementary information about injury, stress, inflammation, and filtration; their interpretation depends on the specimen, assay, timing, and clinical setting. This narrative review examines biomarker translation with a focus on point-of-care DIKI testing in resource-limited HIV/antiretroviral therapy (ART) services. It distinguishes analytical validity, clinical validity, clinical utility, and implementation, and proposes a staged evaluation roadmap. Priorities include reliable measurement under routine conditions, independent validation of decision thresholds, comparison with existing clinical assessments, and prospective evaluation of biomarker-guided care. Economic and equity assessments should accompany clinical studies. Earlier detection is valuable when a reliable result supports an effective clinical response; diagnostic accuracy alone does not establish patient benefit.