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The complexity of kidney disease and diagnosing it - Cystatin C, selective glomerular hypofiltration syndromes and proteome regulation

Malmgren, Linnea LU orcid ; Öberg, Carl LU ; den Bakker, Emil ; Leion, Felicia LU ; Siódmiak, Joanna ; Åkesson, Anna LU orcid ; Lindström, Veronica LU orcid ; Herou, Erik LU orcid ; Dardashti, Alain LU and Xhakollari, Liana LU , et al. (2023) In Journal of Internal Medicine 293(3). p.293-308
Abstract

Estimation of kidney function is often part of daily clinical practice, mostly done by using the endogenous GFR-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, are characterised by a selective reduction in the glomerular filtration of 5-30 kDa molecules, such as cystatin C, compared to the filtration of small molecules < 1kDa dominating the glomerular filtrate e.g., water, urea, creatinine. At least two types of such disorders, shrunken or... (More)

Estimation of kidney function is often part of daily clinical practice, mostly done by using the endogenous GFR-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, are characterised by a selective reduction in the glomerular filtration of 5-30 kDa molecules, such as cystatin C, compared to the filtration of small molecules < 1kDa dominating the glomerular filtrate e.g., water, urea, creatinine. At least two types of such disorders, shrunken or elongated pore syndrome, are possible according to the pore model for glomerular filtration. Selective glomerular hypofiltration syndromes are prevalent in investigated populations, and patients with these syndromes often display normal measured GFR or creatinine-based GFR-estimates. The syndromes are characterised by proteomic changes promoting the development of atherosclerosis, indicating antibodies and specific receptor-blocking substances as possible new treatment modalities. Presently, the KDIGO guidelines for diagnosing kidney disorders do not recommend cystatin C as a general marker of kidney function and will therefore not allow the identification of a considerable number of patients with selective glomerular hypofiltration syndromes. Furthermore, as cystatin C is uninfluenced by muscle mass, diet or variations in tubular secretion and cystatin C-based GFR-estimation equations do not require controversial race or sex terms, it is obvious that cystatin C should be a part of future KDIGO guidelines. This article is protected by copyright. All rights reserved.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
kidney disease, proteomics
in
Journal of Internal Medicine
volume
293
issue
3
pages
293 - 308
publisher
Wiley-Blackwell
external identifiers
  • pmid:36385445
  • scopus:85144025219
ISSN
1365-2796
DOI
10.1111/joim.13589
language
English
LU publication?
yes
id
a22aa2a3-5e22-4250-8d8f-bb7189ff01e0
date added to LUP
2022-11-22 12:57:55
date last changed
2024-10-05 09:12:33
@article{a22aa2a3-5e22-4250-8d8f-bb7189ff01e0,
  abstract     = {{<p>Estimation of kidney function is often part of daily clinical practice, mostly done by using the endogenous GFR-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, are characterised by a selective reduction in the glomerular filtration of 5-30 kDa molecules, such as cystatin C, compared to the filtration of small molecules &lt; 1kDa dominating the glomerular filtrate e.g., water, urea, creatinine. At least two types of such disorders, shrunken or elongated pore syndrome, are possible according to the pore model for glomerular filtration. Selective glomerular hypofiltration syndromes are prevalent in investigated populations, and patients with these syndromes often display normal measured GFR or creatinine-based GFR-estimates. The syndromes are characterised by proteomic changes promoting the development of atherosclerosis, indicating antibodies and specific receptor-blocking substances as possible new treatment modalities. Presently, the KDIGO guidelines for diagnosing kidney disorders do not recommend cystatin C as a general marker of kidney function and will therefore not allow the identification of a considerable number of patients with selective glomerular hypofiltration syndromes. Furthermore, as cystatin C is uninfluenced by muscle mass, diet or variations in tubular secretion and cystatin C-based GFR-estimation equations do not require controversial race or sex terms, it is obvious that cystatin C should be a part of future KDIGO guidelines. This article is protected by copyright. All rights reserved.</p>}},
  author       = {{Malmgren, Linnea and Öberg, Carl and den Bakker, Emil and Leion, Felicia and Siódmiak, Joanna and Åkesson, Anna and Lindström, Veronica and Herou, Erik and Dardashti, Alain and Xhakollari, Liana and Grubb, Gabriel and Strevens, Helena and Abrahamson, Magnus and Helmersson-Karlqvist, Johanna and Magnusson, Martin and Björk, Jonas and Nyman, Ulf and Ärnlöv, Johan and Ridefeldt, Peter and Åkerfeldt, Torbjörn and Hansson, Magnus and Sjöström, Anna and Mårtensson, Johan and Itoh, Yoshihisa and Grubb, David and Tenstad, Olav and Hansson, Lars-Olov and Olafsson, Isleifur and Campos, Araceli Jarquin and Risch, Martin and Risch, Lorenz and Larsson, Anders and Nordin, Gunnar and Pottel, Hans and Christensson, Anders and Bjursten, Henrik and Bökenkamp, Arend and Grubb, Anders}},
  issn         = {{1365-2796}},
  keywords     = {{kidney disease; proteomics}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{293--308}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Internal Medicine}},
  title        = {{The complexity of kidney disease and diagnosing it - Cystatin C, selective glomerular hypofiltration syndromes and proteome regulation}},
  url          = {{http://dx.doi.org/10.1111/joim.13589}},
  doi          = {{10.1111/joim.13589}},
  volume       = {{293}},
  year         = {{2023}},
}