Biomarkers of renal function, which and when?

Area of Science:

• Nephrology
• Biomarker Discovery
• Clinical Diagnostics

Background:

• Acute kidney injury (AKI) and chronic kidney disease (CKD) significantly increase morbidity and mortality.
• Current diagnostic methods rely on surrogate markers of glomerular filtration rate (GFR), such as serum creatinine (SCr), which have limitations.
• Limitations of SCr include inaccuracy in patients with low muscle mass or fluid overload, hindering early diagnosis.

Purpose of the Study:

• To review novel biomarkers for the early diagnosis and risk stratification of AKI and CKD.
• To discuss the potential of these biomarkers to guide interventions and monitor disease progression.
• To highlight the need for further research to implement biomarkers in clinical practice.

Main Methods:

• Review of recent advances in molecular biology and biomarker studies for kidney diseases.
• Analysis of the performance of specific biomarkers (e.g., KIM-1, NGAL, TIMP-2, IGFBP7, cystatin C, FGF-23) in predicting AKI and CKD.
• Evaluation of biomarker combinations for improved diagnostic accuracy and risk stratification.

Main Results:

• KIM-1 and NGAL are effective urine and plasma biomarkers for early AKI prediction.
• Urine TIMP-2 and IGFBP7 show superior performance in predicting moderate to severe AKI.
• NGAL, cystatin C, and FGF-23 are promising biomarkers for CKD detection; combined equations (e.g., cystatin C and SCr) enhance diagnostic accuracy.

Conclusions:

• Promising biomarkers for AKI and CKD diagnoses have emerged, necessitating further research for clinical implementation.
• Successful integration of biomarkers can facilitate early diagnosis, intervention, and disease monitoring.
• Biomarker combinations are crucial for increasing diagnostic accuracy in acute settings and improving risk stratification for kidney disease progression.