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

Linnea Malmgren, Carl Öberg, Emil den Bakker, Felicia Leion, Joanna Siódmiak, Anna Åkesson, Veronica Lindström, Erik Herou, Alain Dardashti, Liana Xhakollari, Gabriel Grubb, Helena Strevens, Magnus Abrahamson, Johanna Helmersson-Karlqvist, Martin Magnusson, Jonas Björk, Ulf Nyman, Johan Ärnlöv, Peter Ridefeldt, Torbjörn ÅkerfeldtMagnus Hansson, Anna Sjöström, Johan Mårtensson, Yoshihisa Itoh, David Grubb, Olav Tenstad, Lars-Olov Hansson, Isleifur Olafsson, Araceli Jarquin Campos, Martin Risch, Lorenz Risch, Anders Larsson, Gunnar Nordin, Hans Pottel, Anders Christensson, Henrik Bjursten, Arend Bökenkamp, Anders Grubb

Research output: Contribution to journalReview articlepeer-review

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 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.

Original languageEnglish
JournalJournal of Internal Medicine
Early online date2022 Nov 17
DOIs
Publication statusE-pub ahead of print - 2022 Nov 17

Subject classification (UKÄ)

  • Urology and Nephrology

Keywords

  • kidney disease
  • proteomics

Fingerprint

Dive into the research topics of 'The complexity of kidney disease and diagnosing it - Cystatin C, selective glomerular hypofiltration syndromes and proteome regulation'. Together they form a unique fingerprint.

Cite this