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Review
. 2020 Dec 18;17(24):9522.
doi: 10.3390/ijerph17249522.

The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review

T D K S C Gunasekara  1 , P Mangala C S De Silva  1   2 , Chula Herath  3 , Sisira Siribaddana  4 , Nipuna Siribaddana  5 , Channa Jayasumana  6 , Sudheera Jayasinghe  7 , Maria Cardenas-Gonzalez  2   8 , Nishad Jayasundara  9   10
Affiliations
Review

The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review

T D K S C Gunasekara et al. Int J Environ Res Public Health. .

Abstract

Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.

Keywords: CKD; CKDu; Sri Lanka; novel biomarkers; renal function; rural farmers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Endemic chronic kidney disease of unknown etiology (CKDu) hotspots and regions with emerging evidence of CKDu and chronic kidney disease (CKD) of nontraditional causes (CKDnT) around the world. Global burden is illustrated as all forms of CKD, including CKDu in countries of low to high socio-demographic index (SDI)-based economic strata.
Figure 2
Figure 2
Macromolecules that may serve as biomarkers and their sites of expression. (KIM-1: Kidney Injury Molecule-1; NGAL: Neutrophil Gelatinase-Associated Lipocalin; TIMP-2: Tissue Inhibitor Metalloproteinase-2; IGFBP-7: Insulin- like Growth Factor Binding Protein-7; Pi-GST: Glutathione S-Transferase; NAG: N-acetyl-beta-D-glucosaminidase; IL-18: Interleukin-18; RBP: Retinol Binding Protein; L-FABP: Liver type Fatty Acid Binding Protein; α1M: α1- Microglobulin; β2M: β2- Microglobulin; HGF: Hepatocyte Growth Factor.).
Figure 3
Figure 3
Overview of commonly used renal biomarkers for screening CKDu affected communities in the Mesoamerican region.
Figure 4
Figure 4
Regional distribution of CKDu in Sri Lanka and currently assessed biomarkers in different communities. Prevalence is illustrated in terms of the number of reported cases in the level of Divisional Secretariat Divisions.
See this image and copyright information in PMC

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