Urine biomarkers in renal allograft

Abstract

There is a high risk for the survival of patients with an end-stage renal disease for kidney transplantation. To avoid rejection by strict medication adherence is of utmost importance to avoid the failure of a kidney transplant. It is imperative to develop non-invasive biomarkers to assess immunity risk, and to ultimately provide guidance for therapeutic decision-making following kidney transplantation. Urine biomarkers may represent the promising non-invasive tools that will help in predicting risk or success rates of kidney transplantations. Furthermore, composite urinary biomarkers or urinary biomarker panel array might be critical in improving the sensitivity and specificity in reflecting various risks of kidney failure during transplantation. This review primarily focuses on the role of such biomarkers in predicting chronic kidney disease (CKD) progression and/or cardiovascular disease (CVD) risk in renal allograft.

Role of Urine Examination in Renal Transplant Recipients

“…Recipients DOI: http://dx.doi.org/10.5772/intechopen.112967 plasma, serum and tissue have been implicated in monitoring renal allograft function. According to WHO, a novel biomarker is defined as a "alteration occurring at cellular, biochemical or molecular level in cells, tissues or body fluid which can be measured and evaluated to indicate the normal biological or a pathogenic processes, or a pharmacological response to a therapeutic intervention [43,44]. Serum creatinine level, is the most commonly used biochemical parameter to assess the renal allograft function, but is not an affective marker to detect early renal dysfunction.…”

“…Serum creatinine level, is the most commonly used biochemical parameter to assess the renal allograft function, but is not an affective marker to detect early renal dysfunction. This happens as creatinine concentration in serum is greatly influenced even by various non-renal factors (factors influencing serum creatinine levels: body weight, race, age, gender, total body volume, drugs, muscle metabolism, protein intake) [4,43]. Additionally, it is not able to predict or evaluate the progression of chronic injury and making it a non-specific or non-predictive marker for graft dysfunction.…”

“…These include readily availability, accuracy, low cost, should be easy to standardized, produce repeatable results and be non-invasive. Overall such a biomarker should be useful to reduce the necessity for performing a renal allograft biopsy and help the clinician for early management [43,44,48].…”

Future strategies to improve short- and long-term outcomes of renal transplantation in dogs

“…In medicine, human noninvasive biomarkers, like the early expression profile of inflammatory markers, liver fatty acid-binding protein, tissue inhibitor metalloproteinase-2, insulin-like growth factor binding protein 7, chemokine ligand 9, chemokine ligand 2, cystatin C, T-cell immunoglobulin domain, and matrix metalloproteinase-7, are used to assess immune risk and ultimately guide therapeutic decision-making following kidney transplantation (McDANIEL et al, 2013;WANG et al, 2016). No such markers exist yet for canine renal transplantation.…”