Acute renal injury leading to acute renal failure is frequently seen in septic or hemorrhagic shock, after cardiac surgery, after administration of x-ray contrast or chemotherapeutic agents, some antibiotics and NSAIDs, rejection of renal grafts and certain types of infections and autoimmune reactions. Up to 50% of patients in intensive care may suffer some degree of acute renal failure, arising either before admission or during hospitalization. The onset of acute renal failure in addition to other critical illness is associated with dramatically increased mortality.

The prognosis for acute renal failure has not improved significantly over the last four decades. Current diagnostic methods such as serum creatinine or cystatin C measurements only respond after renal function has deteriorated, which may only become apparent one or more days after the original insult, when up to 50% of the renal function has been lost. With new early markers for renal injury such as NGAL, physicians can initiate proper management of acute renal failure within hours rather than days of the insult.

The lack of an early diagnostic marker for acute renal failure has held back improvements in treatment methods. New early markers should allow the development of novel treatments and accelerate the transfer of therapeutic candidates from animal models to patient trials. Previous attempts to transfer promising therapeutic agents from animal models to have failed, which may at least in part be due to failure to initiate treatment within the therapeutic window.