Abstract
Serum and Urinary Biomarkers Determination and Their Significance in Diagnosis of Kidney DiseasesChronic kidney disease (CKD) is becoming a major public health problem worldwide due to the epidemic increase of patients on renal replacement therapy and their high cardiovascular morbidity and mortality. The only effective approach to this problem is prevention and early detection of CKD. In addition, despite significant improvements in therapeutics, the mortality and morbidity associated with acute kidney injury (AKI) remain high. A major reason for this is the lack of early markers for AKI, and hence an unacceptable delay in initiating therapy. Therefore, there is a pressing need to develop biomarkers (proteins and other molecules in the blood or urine) for renal disease, which might assist in diagnosis and prognosis and might provide endpoints for clinical trials of drugs designed to slow the progression of renal insufficiency. Besides serum creatinine, promising novel biomarkers for AKI include a plasma panel (neutrophil gelatinase-associated lipocalin-NGAL and cystatin C) and a urine panel (NGAL, kidney injury molecule-1, interleukin-18, cystatin C, alpha 1-microglobulin, Fetuin-A, Gro-alpha, and meprin). For CKD, these include a similar plasma panel and a urine panel (NGAL, asymmetric dimethylarginine, and liver-type fatty acid-binding protein). Increased plasma and urinary TGF-β1 levels might contribute to the development of chronic tubulointerstitial disease, indicating the possible therapeutic implications. Furthermore, to differentiate lower urinary tract infection and pyelonephritis interleukin-6 and serum procalcitonin levels were introduced. It will be important in future studies to validate the sensitivity and specificity of these biomarker panels in clinical samples from large cohorts and in multiple clinical situations.
Highlights
Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence, poor outcome and high treatment costs
Advanced glycation end products (AGEs) are proteins modified by oxidative stress which accumulate in the blood of diabetic and uremic patients
Collagen type IV is a major component of kidney extracellular matrix which is increased during the progression of renal fibrosis
Summary
Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence, poor outcome and high treatment costs. Wide range of insults including infections, toxins, ischaemia, hypertension, genetic or metabolic disorders, autoimmune diseases or allograft rejection can cause kidney damage The effects of these insults may induce AKI, which is clinically defined as a sudden reduction in renal function or urine output [3], or they may induce CKD, in which kidney structural or functional alterations persist for at least 3 months [4]. Growing number of potential renal biomarkers in the serum and urine of patients and animal models of kidney disease have been identified Many of these are still awaiting further testing and clinical validation.
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