Biomarkers in chronic kidney disease: a review

Abstract

Chronic kidney disease (CKD) is a major public health problem. The classification of CKD by KDOQI and KDIGO and the routine eGFR reporting have resulted in increased identification of CKD. It is important to be able to identify those at high risk of CKD progression and its associated cardiovascular disease (CVD). Proteinuria is the most sensitive marker of CKD progression in clinical practice, especially when combined with eGFR, but these have limitations. Hence, early, more sensitive, biomarkers are required. Recently, promising biomarkers have been identified for CKD progression and its associated CVD morbidity and mortality. These may be more sensitive biomarkers of kidney function, the underlying pathophysiological processes, and/or cardiovascular risk. Although there are some common pathways to CKD progression, there are many primary causes, each with its own specific pathophysiological mechanism. Hence, a panel measuring multiple biomarkers including disease-specific biomarkers may be required. Large, longitudinal observational studies are needed to validate candidate biomarkers in a broad range of populations prior to implementation into routine CKD management. Recent renal biomarkers discovered include neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and liver-type fatty acid-binding protein. Although none are ready for use in clinical practice, it is timely to review the role of such biomarkers in predicting CKD progression and/or CVD risk in CKD.

Urinary excretion of angiogenesis regulatory factors and renal injury markers in chronic glomerulonephritis: Significance in the assessment of progression

“…Для ее совершенствования большое значение имеют исследо-вание механизмов прогрессирования хронической болез-ни почек (ХБП) и определение комплекса связанных с ними биомаркеров, позволяющих мониторировать тече-ние заболевания, оценивать эффективность существую-щих методов нефропротекции и разрабатывать новые подходы в том числе путем создания препаратов целена-правленного действия [3].…”

“…К настоящему времени на-коплен большой опыт, свидетельствующий о значении «мочевых тестов» как перспективного направления в изу-чении механизмов прогрессирования ХГН и информатив-ного метода мониторинга результатов лечения [3,[10][11][12].…”

Renal Allograft Fibrosis: Biology and Therapeutic Targets

“…In kidney allografts, increased urinary CCL-2 was associated with renal fibrosis (317). It should be mentioned, however, that most of the mentioned markers are not kidney specific, perhaps except FGF-23, and the true diagnostic value in CKD has not yet been established (379,392). Importantly, none of these markers is specific for interstitial fibrosis but rather reflects other processes.…”

“…Other potentially interesting molecules include the tubular injury markers NGAL (383-385), KIM-1 (385-388), TIMP-2 (389), IGFBP7 (389) and liver-type fatty acid-binding protein (L-FABP) (390,391). The diagnostic value of these markers is well described in acute tubular injury and is being evaluated in the settings of CKD (392) or as a potential marker of ''tubular atrophy'' in allografts (384,393,394). Keratin 18, an epithelial-specific cytoskeletal protein released into urine or serum upon tubular cell death, might also be a novel marker of CKD (395).…”

Urinary Protein Biomarkers in Chronic Kidney Disease

“…Additionally, there is a lack of understanding why some of the CKD patients progress to end-stage renal disease (ESRD) requiring renal replacement therapy (RRT), while others die prematurely due to cardiovascular diseases (CVD) instead of progressing to ESRD [3,[14][15][16][17]. Ultimately, it is important to identify additional noninvasive diagnostic biomarkers for early detection of renal diseases and possible timely therapeutical interventions and prognostics biomarkers as reliable predictors of progression towards ESRD and/or death outcomes [3,4,11,[18][19][20].…”