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2018 ; 3
(2
): 291-301
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Urinary Biomarkers to Identify Autosomal Dominant Polycystic Kidney Disease
Patients With a High Likelihood of Disease Progression
#MMPMID29725632
Messchendorp AL
; Meijer E
; Boertien WE
; Engels GE
; Casteleijn NF
; Spithoven EM
; Losekoot M
; Burgerhof JGM
; Peters DJM
; Gansevoort RT
Kidney Int Rep
2018[Mar]; 3
(2
): 291-301
PMID29725632
show ga
INTRODUCTION: The variable disease course of autosomal dominant polycystic kidney
disease (ADPKD) makes it important to develop biomarkers that can predict disease
progression, from a patient perspective and to select patients for renoprotective
treatment. We therefore investigated whether easy-to-measure urinary biomarkers
are associated with disease progression and have additional value over that of
conventional risk markers. METHODS: At baseline, inflammatory, glomerular, and
tubular damage markers were measured in 24-hour urine collections (albumin, IgG,
kidney injury molecule-1 (KIM-1), N-acetyl-?-d-glucosaminidase (NAG), ?2
microglobulin (?2MG), heart-type fatty acid binding protein (HFABP), macrophage
migration inhibitory factor (MIF), neutrophil gelatinase-associated lipocalin
(NGAL), and monocyte chemotactic protein-1 (MCP-1). Disease progression was
expressed as annual change in estimated glomerular filtration rate (eGFR, Chronic
Kidney Disease EPIdemiology equation), measured glomerular filtation rate (mGFR,
using (125)I-iothalamate), or height-adjusted total kidney volume (htTKV).
Multivariable linear regression was used to assess associations of these markers
independent of conventional risk markers. RESULTS: A total of 104 ADPKD patients
were included (40 ± 11 years, 39% female, eGFR 77 ± 30, mGFR 79 ± 30 ml/min per
1.73 m(2) and htTKV 852 [510-1244] ml/m). In particular, ?2MG and MCP-1 were
associated with annual change in eGFR, and remained associated after adjustment
for conventional risk markers (standardized ? = -0.35, P = 0.001, and
standardized ? = -0.29, P = 0.009, respectively). Adding ?2MG and MCP-1 to a
model containing conventional risk markers that explained annual change in eGFR
significantly increased the performance of the model (final R(2) = 0.152 vs.
0.292, P = 0.001). Essentially similar results were obtained when only patients
with an eGFR ? 60 ml/min per 1.73 m(2) were selected, or when change in mGFR was
studied. Associations with change in htTKV were less strong. CONCLUSION: Urinary
?2MG and MCP-1 excretion were both associated with GFR decline in ADPKD, and had
added value beyond that of conventional risk markers. These markers therefore
have the potential to serve as predictive tools for clinical practice.