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Non-Invasive Biomarkers for Diagnosis, Risk Prediction, and Therapy Guidance of Glomerular Kidney Diseases: A
Lorenzo Catanese1,2,3, Harald Rupprecht1,2,3, Tobias B Huber4
1Department of Nephrology, Angiology and Rheumatology, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany.
Insights
Effective management of glomerular kidney disease requires accurate diagnosis and prognosis. While many biomarkers exist, kidney biopsy remains essential for diagnosis and monitoring, despite its invasive nature.
Area of Science:
- Nephrology
- Biomarker Discovery
- Clinical Diagnostics
Background:
- Glomerular kidney disease is a major cause of chronic kidney disease (CKD).
- Accurate diagnosis, prognosis, and treatment monitoring are crucial for effective management.
- Current non-invasive biomarkers often lack global accessibility or clinical implementation.
Purpose of the Study:
- To review and compile available diagnostic, prognostic, and predictive biomarkers for glomerular diseases.
- To provide guidance on the clinical application of these biomarkers.
- To propose a non-invasive, biomarker-guided diagnostic pathway.
Main Methods:
- Comprehensive literature review of diagnostic, prognostic, and predictive biomarkers for glomerular diseases.
- Analysis of biomarker availability, accessibility, and clinical utility.
- Development of a decision tree for biomarker-guided diagnosis.
Main Results:
- Numerous biomarkers for glomerular diseases are reported in the literature.
- Many biomarkers face challenges in clinical practice due to access, infrastructure, or cost.
- A decision tree for non-invasive biomarker-guided diagnosis has been developed.
Conclusions:
- Valid biomarkers are available for most patients with glomerular diseases.
- Non-invasive strategies show promise but cannot fully replace kidney biopsy.
- Kidney biopsy remains indispensable for diagnosis and monitoring, especially for rare CKD etiologies.
Abstract:
Effective management of glomerular kidney disease, one of the main categories of chronic kidney disease (CKD), requires accurate diagnosis, prognosis of progression, assessment of therapeutic efficacy, and, ideally, prediction of drug response. Multiple biomarkers and algorithms for the assessment of specific aspects of glomerular diseases have been reported in the literature. Though, the vast majority of these have not been implemented in clinical practice or are not available on a global scale due to limited access, missing medical infrastructure, or economical as well as political reasons. The aim of this review is to compile all currently available information on the diagnostic, prognostic, and predictive biomarkers currently available for the management of glomerular diseases, and provide guidance on the application of these biomarkers. As a result of the compiled evidence for the different biomarkers available, we present a decision tree for a non-invasive, biomarker-guided diagnostic path. The data currently available demonstrate that for the large majority of patients with glomerular diseases, valid biomarkers are available. However, despite the obvious disadvantages of kidney biopsy, being invasive and not applicable for monitoring, especially in the context of rare CKD etiologies, kidney biopsy still cannot be replaced by non-invasive strategies.
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