Novel early markers of chronic kidney disease

Abstract

Chronic kidney disease is an irreversible kidney damage caused by structural or functional renal impairment and persisting for more than 3 months. It is usually accompanied by albuminuria, proteinuria, abnormal histopathological and imaging findings as well as a drop in glomerular filtration rate below 60 mL/min/1.73 m 2 . Due to the increasing number of patients, chronic kidney disease is referred to as "the epidemic of the 21 st century. " Early diagnosis allows for effective therapeutic intervention, which makes it possible to inhibit pathological processes and prevent disease in the future. Diagnostic difficulties in detecting early stages of chronic kidney disease are due to their asymptomatic nature and the fact that the markers widely used for renal function assessment are not very sensitive. Therefore, new, early, sensitive and specific markers of renal damage, whose introduction in everyday clinical practice would give a chance of a diagnosis at the very onset of the disease, before irreversible changes occur, are currently being sought. Although the results of scientific research are ambiguous, some of the candidate protein markers seem very promising. These include uromodulin, KIM-1, NGAL-1, NAG, FGF23, RBP4 and suPAR. The aim of the paper was to present a review of the latest research on the use of novel protein markers in the diagnosis of chronic kidney disease in paediatric and internal medicine patients.

The Role of Urinary NGAL in the Management of Primary Vesicoureteral Reflux in Children

“…The Schwartz formula, which was developed in 1976, uses serum creatinine (mg/dL, measured using the Jaffe test), height (cm), and the coefficient k, which is proportional to muscle mass and depends on age and sex. However, the error of GFR calculated from serum creatinine has been shown to be approximately ±20% and ±30-40% in children [54]. In children under 2 years of age, GFR can also be underestimated due to the immaturity of the urinary tract.…”

Advances in Optical Sensors of N-Acetyl-β-d-hexosaminidase (N-Acetyl-β-d-glucosaminidase)

“…Early stage detection of CKD is challenging since most patients are asymptomatic, and the diagnosis is often made incidentally during an encounter for an unrelated health concern. Many urinary biomarkers have been investigated over several decades as potential indicators of AKI or CKD, and HEX­(NAG) is one of the few urinary protein biomarkers that is an enzyme. − There are many risk factors for elevated urinary HEX­(NAG) including the following: diabetes, opportunistic infection including COVID-19, sepsis, malaria, pregnancy, severe trauma, hypovolemia, old age, acute organ failure, major surgery, nephrotoxic antibiotics or cancer chemotherapy, kidney transplantation, cirrhosis, dosing with imaging contrast-agent, and autoimmune disorders. − Provided in Table S1 is a list of typical changes in urinary HEX­(NAG) levels that have been reported in a wide range of clinical circumstances. In most cases, HEX­(NAG) levels are elevated several-fold, but in some cases the increases are less than 2-fold, and there is often considerable dispersion in the measured values for a specific patient cohort.…”