What is the role of biomarkers in the diagnosis of chronic kidney disease (CKD) in children?

Updated: Jul 21, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Although elevated serum creatinine and proteinuria are the most frequently utilized biomarkers of chronic kidney disease (CKD), creatinine and proteinuria increase relatively late in the course of kidney damage and progression in CKD. Novel biomarkers may identify children with the earliest stages of injury and repair, before proteinuria or serum creatinine identifies irreversible injury and nephron loss.

Because CKD progression involves multiple processes in the kidney, it is unlikely that one biomarker will best predict glomerular filtration rate (GFR) decline. It is likely that panels of biomarkers that leverage the additive properties of each individual biomarker will be the most useful clinical tools in identifying risk of CKD progression in children. A panel of biomarkers that represent the multifactorial pathophysiologic mechanisms leading to CKD progression, including tubulointerstitial injury, fibrosis, inflammation, and repair, may prove useful for predicting GFR decline in children.

A study showed that urine neutrophil gelatinase-associated lipocalin (NGAL) predicted CKD progression, but this biomarker did not significantly improve on a clinical model of CKD risk factors, including estimated glomerular filtration rate (eGFR) and proteinuria. However, tumor necrosis factor receptor 1 (TNFR1) and tumor necrosis factor receptor 2 (TNFR2) had a strong association with progression to end-stage renal disease (ESRD) even after controlling for albuminuria and eGFR. [17]  

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