Abstract:
Spectrum of kidney disease could be roughly divided in chronic kidney disease (CKD) and acute kidney injury (AKI), previously named acute renal failure. CKD mainly consists of steady or progressive loss of renal function with a slow but continuous decrease in glomerular filtration rate (GFR); AKI, on the other hand, is characterized by tubular necrosis, oliguria and tissue damage. CKD has been identified as a worldwide public health problem involving a rising incidence and prevalence of the disease: they are approximately twice what they were 10 years ago. The recognition of CKD as a public health problem has evolved, in part, from the acceptance of the conceptual model, definition, and classification of CKD proposed by the NKF/KDOQI initiative in 2002. CKD has an insidious onset and is generally detected at a time when it is clinically quite advanced; adverse outcomes of CKD can be prevented through early detection and treatment. The public health mandate is clear for governments: detection and prevention are the most cost-effective methods to address CKD and its impact on diabetes and cardiovascular (CV) disease. Early stages of CKD can be detected through routine laboratory measurements. Over the past 100 years, diagnosis, prognosis, and follow-up of renal failure have been based upon serum creatinine measurement and creatinine clearance calculation. Only 60% of patients with decreased GFR had increased serum creatinine and creatinine clearance systematically overestimates GFR 10-40% in healthy subjects, but is greater and more unpredictable in patients with CKD. Therefore, in 2002 the K/DOQI guidelines recommended to use equations estimating GFR based on serum creatinine, being more accurate and precise than estimates of GFR from measurements of serum creatinine alone. However, an accurate, non-invasive, and convenient estimation of GFR has been not identify. Thus, there is a growing demand for a clinically convenient and reliable marker of renal function. The clinical significance of such biochemical markers, e.g.: cystatin C, albuminuria, NGAL, KIM-1, caspases, meprin 1?, TGF-?, etc., will be discussed for the early diagnosis and monitoring of CKD and AKI.