Bridging conventional clinical tests and advanced biomarkers for the early diagnosis of kidney disease progression
DOI:
https://doi.org/10.12669/pjms.41.11.12785Keywords:
Acute kidney injury, CKD, Fetuin-A, Asymmetric dimethylarginine, Neutrophil gelatinase-associated lipocalin, uromodulin, klotho, beta-2 microglobu, beta-2 microglobulinAbstract
Objective: This study aimed to evaluate and validate the applicability and reliability of seven biomarkers for the early detection of kidney diseases in the Pakistani population.
Methodology: A case-control study involving two hundred participants was conducted at Nishtar and Ibn-e-Siena Hospitals, Multan, from January to December 2022. Seven serum biomarkers, klotho, uromodulin, neutrophil gelatinase-associated lipocalin (NGAL), beta-2 microglobulin, asymmetric dimethyl arginine (ADMA), beta trace protein, and fetuin-A, were exploited, and their levels were measured by enzyme-linked immunosorbent assay (ELISA) kits. Diagnostic performance of these biomarkers was measured through the receiver-operator curve (ROC) via GraphPad Prism. Correlations among biomarkers were assessed by matrix scatter plots, while protein-protein interactions were analyzed using STRING. Data was statistically analyzed using one-way analysis of variance (ANOVA) and the Tukey’s multiple comparison test.
Results: The results demonstrated a significantly reduced eGFR and elevated creatinine levels in chronic kidney disease (CKD) and acute kidney injury (AKI) patients compared to controls. Additionally, all seven diagnostic serum biomarkers were found to be associated with CKD. Uromodulin level was lower in AKI (35ng/ml ±3.8) verses CKD (41.7ng/ml±14.3) patients, while other biomarkers were significantly higher in AKI. Receiver-operator curve (ROC) analysis showed excellent CKD detection, particularly by BTP, NGAL, B2M, ADMA, and uromodulin (AUC>0.99). Furthermore, klotho correlated positively with several biomarkers, while uromodulin had negative correlations, and NGAL showed strong positive correlations overall. STRING results revealed strong interactions among B2M biomarker with uromodulin.
Conclusions: The BTP, ADMA, and Klotho show good potential for improving early diagnosis and differentiation of CKD and AKI, supporting timely and clinical interventions.
