Methods and compositions for diagnosis and prognosis of renal injury and renal failure

A method of treating a subject comprising:

• (a) detecting an elevated level of insulin-like growth factor-binding protein 7 (IGFBP7) in a urine sample obtained from the subject as compared to a predetermined threshold level, wherein the threshold level is selected based on results of a population study of individuals, and wherein the results separate the population into a first subpopulation of the individuals with a level of IGFBP7 that is greater than the threshold level and a second subpopulation of the individuals with a level of IGFBP7 that is less than the threshold level;
• (b) determining that the subject is at risk of a future acute kidney injury within 48 hours of the time the urine sample is obtained from the subject based on the elevated level of insulin-like growth factor-binding protein 7 in the sample, and;
• (c) treating the subject determined to be at risk of the future acute kidney injury, wherein the treatment comprises initiating renal replacement therapy, ceasing administration of compounds to the subject that are known to be damaging to the kidney, or modifying diuretic administration of compounds,
• wherein the subject:
• (i) is undergoing or has undergone an acute medical event which predisposes the subject for developing the acute kidney injury;
• or (ii) has been exposed to an agent that predisposes the subject for developing the acute kidney injury.