Diagnosi, monitoraggio e prevenzione delle patologie renali
|Biochimica Clinica 2021; 45(3) s005-s007
Pubblicato online il: 03.08.2021
I biomarcatori di danno renale acuto
Biomarkers of acute kidney injury
The diagnosis and follow-up of acute kidney injury (AKI) has traditionally been based on clinical parameters such as urine output, and/or biomarkers such as serum creatinine (sCr), which are not very sensitive. The identification and validation of novel biomarkers, capable of recognizing an increased risk of AKI, a renal damage before or without a functional renal loss (i.e. subclinical AKI) and a renal dysfunction prior to the increase in sCr levels, has reviewed the diagnosis and classification of AKI. Thanks to these biomarkers, a new conceptual model of AKI, that includes the full spectrum of events and conditions, has been developed. At each stage of this model, biomarkers may contribute to explain the mechanisms and to predict the clinical evolution of kidney damage. Several biomarkers have been identified. They differ in anatomical origin, physiological function, kinetics and detecting time after kidney injury.
|TAG: biomarcatori danno renale acuto disfunzione|
|Biochimica Clinica 2021; 45(3) s008-s017
Pubblicato online il: 30.03.2021
Current trends and future directions of liquid biopsy in renal cell carcinoma
Metastatic clear cell renal cell carcinoma is a high vascularized and aggressive tumor characterized by a high intra-tumoral and inter-tumoral heterogeneity. For this reason, despite the wide range of therapy available, these patients often show resistance to chemotherapy. In this scenario, it could be of great benefit the discovery of biomarkers to identify the most suitable treatment for first and second line therapy and the early determination of outcome. Once identified, circulating biomarkers could be introduced in clinical practice and integrated with patient’s clinical features for building a decision algorithm usable by clinicians. The liquid biopsy, defined as the determination in fluids like blood of tumor-released product such as DNA, RNA and protein, exhibits several advantages over tissue biomarkers including a real time correlation with tumor features, lower cost and lower risk for the patient. Our understanding of the liquid biopsy has raised rapidly in the last few years accordingly with the development of new molecular biology techniques. Efforts are under way for the identification of robust and reproducible liquid biopsy assays that could improve soon overall survival (OS) and quality of life of metastatic renal cell carcinoma.
|TAG: clear cell renal carcinoma liquid biopsy free nucleic acids|
|Biochimica Clinica 2021; 45(3) s018-s024
Pubblicato online il: 25.03.2021
Renal amyloidoses are a group of rare misfolding protein diseases caused by the deposition of a precursor protein in the kidney as insoluble amyloid fibrils, causing renal damage and dysfunction that can progress to end-stage renal failure requiring dialysis. This heterogeneous group includes commoner diseases as light chain (AL) and reactive (AA) amyloidosis as well as rarer entities as hereditary renal amyloidosis. Differential diagnosis is mandatory to avoid therapeutic errors and requires amyloid typing on tissue biopsy and, in selected cases, DNA analysis. In AL and AA amyloidosis, biomarkers are well-established tools that help clinicians in diagnosis, prognosis assessment and evaluation of treatment efficacy, highlighting the important role of the clinical laboratory in the management of these rare diseases. In AL amyloidosis, the identification of the monoclonal protein requires the combination of electrophoresis, immunofixation of both serum and urine, and serum free light chain (FLC) assessment. Severity of renal involvement and risk of progression to dialysis are predicted at diagnosis by 24h-proteinuria and estimated glomerular filtration rate (eGFR). Treatment efficacy is assessed with monoclonal protein studies, including serum FLC measurement; hematologic response can result in improvement of renal damage, evaluated by improvements in 24h-proteinuria and eGFR from baseline. In AA amyloidosis, a periodical evaluation of serum amyloid A (SAA) serum concentration reflects the activity of the underlying inflammatory disease and evaluates the efficacy of treatment. The severity of renal involvement can be assessed at diagnosis with 24h-proteinuria and eGFR. Only few data on prognostic markers are available on other types of renal amyloidosis.
|TAG: amiloidosi danno renale prognosi|
|Biochimica Clinica 2021; 45(3) s025-s036
Pubblicato online il: 10.05.2021
Rene policistico: dall’ereditarietà complessa alla terapia
Policistic kidney disease: from genetic complexity to therapy
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a major genetic disorder affecting up to 12.5 million individuals worldwide and it is the fourth most common global cause for renal replacement therapy.
|TAG: rene policistico ereditarietà complessa variabilità genpotipo-fenotipo|
|Biochimica Clinica 2021; 45(3) s037-s047
Pubblicato online il: 01.06.2021
Malattia renale nel diabete: oltre la nefropatia diabetica
Kidney disease in diabetes: beyond diabetic nephropathy
Chronic kidney disease is a major type of kidney disease where a gradual loss of kidney function over a period of months to years can be observed. Its early detection is critical in improving the clinical outcome. It may be associated to diabetes, the illness being cause of the nephropathy, and then the condition is known as diabetic kidney disease (DKD). However, it may be associated to diabetes, but the pathogenesis arising could be attributable to other reasons, and then the condition is known as non diabetic kidney disease (NDKD). In this review we will focus on these two conditions, and we will briefly outline the state of the art of some traditional biomarkers (the quantitative determination of albumin in urine, eGFR), the role and the interpretation of some established biomarkers for the evaluation of glycemic control (glycated hemoglobin and glycated albumin) and the potential use of other new biomarkers useful to predict the development of the nephropathy.
|TAG: diabete albuminuria nefropatia|
|Biochimica Clinica 2021; 45(3) s048-s059
Pubblicato online il: 08.06.2021
Valutazione critica e meta-analisi delle stime di variabilità biologica degli analiti relativi alle patologie renali
Critical appraisal and meta-analysis of biological variation estimates for kidney related analytes
Objective: Kidney markers are some of the most frequently used laboratory tests in patient care, and correct clinical decision making depends upon knowledge and correct application of biological variation (BV) data. The aim of this study was to review available BV data and to provide updated BV estimates for the following kidney markers in serum and plasma; albumin, creatinine, cystatin C, chloride, potassium, sodium and urea.
|TAG: variabilità biologica obiettivi di qualità analitica meta analisi|
|Biochimica Clinica 2021; 45(3) s060-s070
Pubblicato online il: 10.03.2021
Contributi Scientifici -
Potenziale ruolo dell’Human Epididymis Protein 4 come biomarcatore nella nefropatia mesangiale a depositi di IgA
Potential role of Human Epididymis Protein 4 (HE4) as biomarker for IgA Nephropathy
Introduction: Human Epididymis Secretory Protein 4 (HE4) serum concentrations have been widely investigated in patients with ovarian cancer. However, high levels of HE4 can be also found in other tumors and in renal fibrosis. The aim of this study was to assess serum HE4 levels in a cohort of patients with IgA Nephropathy (IgAN) and the correlation of this potential biomarker with the degree of fibrosis.
|TAG: HE4 nefropatia IgA fibrosi renale|
|Biochimica Clinica 2021; 45(3) s071-s075
Pubblicato online il: 06.04.2021
Contributi Scientifici -
Stato dell’arte dei biomarcatori di malattia renale osservato mediante i Programmi di VEQ del Centro di Ricerca Biomedica
The quality of laboratory tests for the Chronic Kidney Disease in Italy through EQA programs
Introduction: the diagnosis and classification of Chronic Kidney Disease (CKD) are based on laboratory tests. The aim of this paper is to verify their harmonization at national level, through the examination of participants’ results to EQA programs of the Centre of Biomedical Research.
|TAG: Programmi di Valutazione Esterna di Qualità creatinina albuminuria|
|Biochimica Clinica 2021; 45(3) s076-s089
Pubblicato online il: 02.08.2021
Contributi Scientifici -
Valutazione della filtrazione glomerulare: riflessione sull’impiego clinico
Evaluation of the glomerular filtration rate from the clinical point of view
In this paper I briefly discuss what the nephrologist means by “renal function” from a clinical point of view, and what can be inferred from the determination of the Glomerular Filtration Rate (GFR). Furthermore, I illustrate the use of serum biomarkers: serum creatinine, and GFR (measured and estimated GFR with different formulas), together with their limitations in different clinical conditions (acute kidney injury versus chronic kidney disease), different ages, different patients (obese, HIV patientsts, different ethnic groups). Forthcoming new methods for the point-of-care, rapid GFR determination are described with their possible implications in the acute kidney injury setting.
|TAG: funzione renale clearance della creatinina velocità di filtrazione glomerulare|
|Biochimica Clinica 2021; 45(3) s090-s096
Pubblicato online il: 19.07.2021
Proteinuria nel COVID-19: l’importanza di un esame consolidato in una patologia complessa
|TAG: danno renale acuto proteinuria SARS-CoV-2|
|Biochimica Clinica 2021; 45(3) s097-s099
Pubblicato online il: 01.07.2021
Lettere all'editore -
Una nuova equazione dell’European Kidney Function Consortium per la stima della filtrazione glomerulare: implicazioni cliniche delle scelte del laboratorio
|TAG: velocità di filtrazione glomerulare funzione renale formule per la stima della GFR|
|Biochimica Clinica 2021; 45(3) s100-s103
Pubblicato online il: 08.07.2021
Lettere all'editore -
Utilizzo della differenza critica per una corretta interpretazione dei valori di creatinina sierica
|TAG: creatinina variabilità biologica differenza critica|
|Biochimica Clinica 2021; 45(3) s104-s106
Pubblicato online il: 13.07.2021
Lettere all'editore -
Remissione di iperparatiroidismo secondario dopo nefrectomia in un paziente emodializzato: ruolo di Etelcalcetide
Secondary hyperparathyroidism remission after nephrectomy in a dialysis patient: role of Etelcalcetide
Secondary hyperparathyroidism (HPT) is a common issue in dialysis patients; it contributes significantly to their morbidity and mortality. Here we describe the case of a hemodialysis patient with severe secondary HPT, treated with Etelcalcetide, the new intravenous calcimimetic agent, employed after a nephrectomy due to a renal neoplasm to reduce successfully the serum levels of parathyroid hormone (PTH) and bone specific alkaline phosphatase (BAP). No significant change in serum calcium was recorded during treatment, while the already high serum phosphorus concentrations further increased after surgery. By maintaining the calcium mimetic therapy, even if at lower doses, the concentrations of PTH and BAP remained constant over the time.
|TAG: iperparatiroidismo secondario nefrectomia Etelcalcetide|
|Biochimica Clinica 2021; 45(3) s107-s110
Pubblicato online il: 23.07.2021
Casi clinici -