Abstract
Interstitial fibrosis is the common endpoint of end-stage chronic kidney disease (CKD) leading to kidney failure. The clinical course of many renal diseases, and thereby of CKD, is highly variable. One of the major challenges in deciding which treatment approach is best suited for a patient but also in the development of new treatments is the lack of markers able to identify and stratify patients with stable versus progressive disease. At the moment renal biopsy is the only means of diagnosing renal interstitial fibrosis. Novel biomarkers should improve diagnosis of a disease, estimate its prognosis and assess the response to treatment, all in a non-invasive manner. Existing markers of CKD do not fully and specifically address these requirements and in particular do not specifically reflect renal fibrosis. The aim of this review is to give an insight of the involvement of the extracellular matrix (ECM) proteins in kidney diseases and as a source of potential novel biomarkers of renal fibrosis. In particular the use of the protein fingerprint technology, that identifies neo-epitopes of ECM proteins generated by proteolytic cleavage by proteases or other post-translational modifications, might identify such novel biomarkers of renal fibrosis.
Highlights
Interstitial fibrosis is the common endpoint of end-stage chronic kidney disease (CKD) leading to kidney failure
Review Renal fibrosis is the principal pathological process underlying the progression of chronic kidney disease (CKD) and leading to end-stage renal disease (ESRD)
Patients with progressive early function decline showed a decreased expression of fragments of collagen type IV (α1 chain) compared with control subjects with stable renal function [59]. These results suggest that urinary collagen type IV might be a promising additive biomarker in patients with diabetic nephropathy and further clinical studies are eagerly awaited
Summary
The identification of reliable biomarkers for early diagnosis and prognosis of renal fibrosis is of paramount importance. The perfect biomarker for kidney fibrosis should be non-invasive, specific, involved in the mechanisms of fibrosis, with low (or no) background in healthy individuals and able to reflect treatment effects. Several molecules implicated in the mechanisms of fibrosis have been proposed as biomarkers, but none of them have been validated and accepted in clinical practice yet. In this review we have proposed a new perspective, introducing the possible use of ECM protein fingerprint as a source of novel biomarkers for renal fibrosis. PB, DL and MK critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript
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