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Podometrics as a potential clinical tool for glomerular disease management #MMPMID26215862
Kikuchi M; Wickman L; Hodgin J; Wiggins RC
Semin Nephrol 2015[May]; 35 (3): 245-55 PMID26215862show ga
Chronic Kidney Disease culminating in End Stage Kidney Disease is a major public health problem costing in excess of $40 billion per year with high morbidity and mortality. Current tools for glomerular disease monitoring lack precision and contribute to poor outcome. The podocyte depletion hypothesis describes the major mechanisms underlying progression of glomerular diseases responsible for >80% of ESKD. The question arises whether this new knowledge can be used to improve outcomes and reduce costs. Podocytes have unique characteristics that make them an attractive monitoring tool. Methodologies for estimating podocyte number, size, density, glomerular volume and other parameters in routine kidney biopsies, and the rate of podocyte detachment from glomeruli into urine (?podometrics?), have now been developed and validated. They potentially fill important gaps in the glomerular disease monitoring toolbox. Application of these tools to glomerular disease groups demonstrates good correlation with outcome, although data validating their use for individual decision-making is not yet available. Given the urgency of the clinical problem we argue that the time has come to focus on testing these tools for application to individualized clinical decision-making towards more effective progression prevention.