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Clinical Application of Renal Biomarkers

Authors: Autumn N. HarrisDVM, DACVIM (SAIM), & Eleanor BrownDVM

While new biomarkers may help in the detection of kidney disease, it is unlikely that a single biomarker will be able to provide a global picture of kidney function or injury in an individual animal.

idney disease in dogs and cats is common; estimated prevalence ranges from 7% to 20%.1 The International Renal Interest Society (IRIS) has established guidelines for clinical staging and grading of kidney disease with criteria for acute kidney injury (AKI) and chronic kidney disease (CKD). These guidelines have helped veterinarians identify cases in which there is kidney injury or disease that might be mitigated by therapeutic intervention. Despite the clinical significance of kidney disease, however, early detection of kidney injury remains challenging.

The most accurate assessment of renal function is considered to be measurement of glomerular filtration rate (GFR).2,3 However, this procedure is labor-intensive and time-consuming, making it an impractical test in daily clinical practice. Indirect assessment of renal function using serum creatinine and blood urea nitrogen (BUN) is easy to perform, and these tests are widely available. However, both analytes have well-established limitations, resulting in a lack of sensitivity and specificity for detection of kidney disease.4 These values typically do not increase until approximately 75% of the functional renal mass is lost.5,6

Identifying novel biomarkers for kidney injury and disease is appealing and would provide additional tools for diagnosing and monitoring affected dogs and cats. Ideal biomarkers for the detection of kidney disease would be specific (i.e., not affected by comorbidities), strongly correlated with GFR, and more sensitive than serum creatinine for detecting disease. In addition, ideal biomarkers could be used to determine severity and location of the injury as well as to monitor disease progression or response to therapy, and testing would be readily available from a reference laboratory or as an in-clinic assay. A few promising candidates have been found to be useful for evaluating kidney disease in clinical and research settings (FIGURE 1). This review describes the current evidence with regard to widely available renal biomarkers for dogs and cats and their potential utility in clinical practice.

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[Source: Today’s Veterinary Practice]

[Image: GaiBru Photo/shutterstock.com]