Perspectiva pentru noi biomarkeri în afectarea renală acută și cronică

Abstract

The biological marker is defined as a measurable indicator of physiological and pathological biological processes useful in assessing the stage of the disease and the pharmacological response to therapy. The paper proposes a review of biomarkers recently involved in the early diagnosis of acute renal impairment, prognostic prediction in chronic kidney disease, glomerular nephropathy and nephrotoxicity. Clinical trials targeting biomarkers with application in monitoring the development, staging levels of severity for major adverse renal events, assess the response to therapeutic intervention, risk prediction and prognosis. In the last decade, considerable progress has been made in the discovery, development and validation of new biomarkers. Advances in biotechnology are essential for the success of clinical trials and their application in current clinical practice. A number of urinary or serum proteins, molecules and more recently microRNAs have been rigorously investigated as possible markers in acute kidney disease, chronic kidney disease, forms of glomerulonephritis and autosomal dominant polycystic kidney disease. The validation of the new biomarkers implies a long process and the implementation requires a standardized methodology, optimal cost-benefit ratio, certain efficiency for diagnosis, therapy and prognosis. Medical practice guidelines propose the combined use of new biomarkers for the improvement of clinical diagnosis, management and prognosis in renal impairment. The proposed model is the one that includes the classic predictive indicators in association with new biological or genetic markers as the only way for high quality therapeutic intervention and prognosis improvement. Biomarkers such as IL-18, NGAL, LFABP, KIM-1 can help to characterize glomerular or tubular function, interstitial injury, or inflammation. The measurement of biomarkers is possible in specialized centers with laboratories equipped to the highest technological standards and the cost-benefit aspect should not be an impediment.