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Urinary Microcholesterol and Adverse Kidney Outcomes in CKD
Hirotaka Furuta1, Ryosuke Umeda1, Masato Hoshi2
1Department of Nephrology, Fujita Health University School of Medicine, 1-98, Kutsukakecho Dengakugakubo, Toyoake city, Aichi, Japan.
Kidney International Reports
|June 19, 2026
Summary
Urinary microcholesterol (U-mCHO) predicts adverse kidney outcomes in chronic kidney disease (CKD). Higher U-mCHO levels are linked to increased risk of major adverse kidney events (MAKE), suggesting its potential as a biomarker for kidney lipid injury.
Area of Science:
- Nephrology
- Biomarkers
- Lipid Metabolism
Background:
- Urinary microcholesterol (U-mCHO) may indicate kidney injury via impaired lipid handling.
- Its prognostic significance in chronic kidney disease (CKD) is not well-established.
Purpose of the Study:
- To investigate the association between U-mCHO and adverse kidney outcomes in patients with CKD.
- To evaluate U-mCHO as a potential noninvasive biomarker for kidney lipid injury.
Main Methods:
- A cohort study included 1562 CKD patients with baseline estimated glomerular filtration rate (eGFR) ≥ 15 ml/min/1.73 m².
- U-mCHO levels were measured, and patients were followed for major adverse kidney events (MAKE50: ≥50% eGFR decline, kidney replacement therapy, or kidney death).
- Multivariable Cox models and subgroup analyses for patients with low proteinuria (MAKE30: ≥30% eGFR decline) were performed.
Main Results:
- Higher U-mCHO levels were significantly associated with an increased risk of MAKE50 (adjusted HR: 7.30).
- This association remained consistent across subgroups, including those with low proteinuria (MAKE30 HR: 3.06).
- No significant interaction was found between U-mCHO and proteinuria levels (P = 0.89).
Conclusions:
- U-mCHO is independently associated with major adverse kidney events in CKD patients.
- U-mCHO shows potential as a noninvasive biomarker for kidney lipid injury, even in patients with low proteinuria.
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