Abstract
In its early stages, symptoms of chronic kidney disease (CKD) are usually not apparent. Significant reduction of the kidney function is the first obvious sign of disease. If diagnosed early (stages 1 to 3), the progression of CKD can be altered and complications reduced. In stages 4 and 5 extensive kidney damage is observed, which usually results in end-stage renal failure. Currently, the diagnosis of CKD is made usually on the levels of blood urea and serum creatinine (sCr), however, sCr has been shown to be lacking high predictive value. Due to the development of genomics, epigenetics, transcriptomics, proteomics, and metabolomics, the introduction of novel techniques will allow for the identification of novel biomarkers in renal diseases. This review presents some new possible biomarkers in the diagnosis of CKD and in the prediction of outcome, including asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), uromodulin, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), miRNA, ncRNA, and lincRNA biomarkers and proteomic and metabolomic biomarkers. Complicated pathomechanisms of CKD development and progression require not a single marker but their combination in order to mirror all types of alterations occurring in the course of this disease. It seems that in the not so distant future, conventional markers may be exchanged for new ones, however, confirmation of their efficacy, sensitivity and specificity as well as the reduction of analysis costs are required.
Highlights
Characteristic features of chronic kidney disease (CKD) involve progressive destruction of the renal parenchyma and the loss of functional nephrons [1,2]
Due to the fact that the biological role of differentially expressed urinary-derived exosomal miRNAs remains to be unravelled, it can only be hypothesized whether a significant increase of miR-181a in healthy controls is associated with enhanced export of miR-181a into exosomes from healthy kidney cells or whether miR-181a expression is down-regulated in kidney cells of CKD patients
New validated biomarkers are required for CKD progression and cardiovascular disease (CVD) risk
Summary
Characteristic features of chronic kidney disease (CKD) involve progressive destruction of the renal parenchyma and the loss of functional nephrons [1,2]. The loss of function in the course of chronic kidney disease is associated with interstitial fibrosis and inflammation Diagnosis of this disease is important step in the prevention of CKD complications. Steubl et al [8] suggested that due to the curvilinear relationship between serum creatinine and estimated glomerular filtration rate (eGFR), creatinine serum concentrations were increased in serum only when approximately 40–50% of renal parenchyma was reversibly or irreversibly damaged This may lead to the lack of detection of early stages of acute or chronic kidney failure and to the delayed application of detailed diagnostics and the implementation of therapeutic interventions. Kielstein et al [48] demonstrated that SDMA was an early marker of change in GFR after living-related kidney donation
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