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Periostin and KIM-1 as Fibrosis-Related Markers Associated with CKD Stage in Children
Agnieszka Pukajło-Marczyk1, Anna Medyńska1, Anna Jakubowska1
1Clinical Department of Paediatric Nephrology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland.
Insights
New biomarkers, periostin (POST) and kidney injury molecule-1 (KIM-1), show promise for early chronic kidney disease (CKD) detection in children. Their fractional excretion, not absolute levels, correlates with CKD stage and tubular injury.
Area of Science:
- Pediatric Nephrology
- Biomarker Discovery
- Chronic Kidney Disease Research
Background:
- Early diagnosis of chronic kidney disease (CKD) in children is crucial but challenging.
- Periostin (POST) and kidney injury molecule-1 (KIM-1) are potential biomarkers for tubular injury and fibrosis.
- The utility of these biomarkers in pediatric CKD requires further investigation.
Purpose of the Study:
- To assess the association of serum and urinary POST and KIM-1 with CKD stage in children.
- To evaluate the relationship between these biomarkers and renal function (eGFR) and proteinuria.
- To determine if fractional excretion indices (FePOST, FeKIM-1) offer insights into CKD progression.
Main Methods:
- Studied 23 children with CKD stages I-IV and 23 healthy controls.
- Measured serum/urinary POST, KIM-1, creatinine, cystatin C, proteinuria, albuminuria, and urinary α1-/β2-microglobulin.
- Analyzed biomarker levels, fractional excretion indices, and their correlation with CKD stage, eGFR, and proteinuria.
Main Results:
- CKD patients showed higher POST, KIM-1, and fractional excretion indices compared to controls.
- Absolute biomarker levels did not differ between early (ES) and late stage (LS) CKD.
- Fractional excretion of POST and KIM-1 (FePOST, FeKIM-1) increased with CKD stage, correlated with reduced eGFR and tubular injury markers.
- The FePOST/FeKIM-1 ratio was elevated in early CKD and remained stable, suggesting sensitivity for early detection.
Conclusions:
- Fractional excretion of POST and KIM-1 is linked to CKD stage and tubular injury in pediatric patients.
- The FePOST/FeKIM-1 ratio may serve as a sensitive indicator for early-stage CKD in children.
- These biomarkers hold potential for improving early diagnosis and monitoring of pediatric CKD.
Abstract:
Early diagnosis of chronic kidney disease (CKD) remains a major clinical challenge. Periostin (POST) and kidney injury molecule-1 (KIM-1) have been proposed as biomarkers of tubular injury and fibrosis. This study aimed to evaluate their utility as markers associated with CKD stage and their associations with renal function and proteinuria in children. Twenty-three children with CKD stages I-IV and 23 healthy controls were enrolled. Serum and urinary POST and KIM-1 were measured together with creatinine (CR), cystatin C (CysC), proteinuria, albuminuria, and urinary α1- and β2-microglobulin. Patients were classified as early stage (ES; CKD I-II) or late stage (LS; CKD III-IV). Serum and urinary POST and KIM-1, uPOST/CR, uKIM-1/CR, fractional excretion indices (FePOST, FeKIM-1), and UPCR were higher in CKD patients than in controls. Absolute biomarker concentrations did not differ between ES and LS and were not associated with eGFR, UPCR, UACR, or tubular protein excretion. In contrast, uPOST/CR, uKIM-1/CR, FePOST, and FeKIM-1 increased with CKD stage, were higher in LS than ES, correlated positively with CysC, and inversely with eGFR. FePOST and FeKIM-1 also correlated strongly with tubular protein markers. The FePOST/FeKIM-1 ratio was elevated in ES patients compared with controls and remained stable across CKD stages. Fractional excretion of POST and KIM-1 is associated with CKD stage and reflects ongoing tubular injury in children. The FePOST/FeKIM-1 ratio may represent a sensitive marker of early CKD.
