Higher urine alpha-1-microglobulin concentration linked to incident CKD in some patients
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Key takeaways:
- A twofold increase in alpha-1-microglobulin concentration was linked to incident CKD.
- Kidney tubule biomarkers may potentially identify early tubulointerstitial disease.
Higher urine alpha-1-microglobulin concentration may be associated with incident chronic kidney disease in patients without prevalent CKD or diabetes, according to published data.
“The need for sensitive and noninvasive measures of tubulointerstitial health fuels the development of new kidney biomarkers,” Jonathan G. Amatruda, MD, of the University of California San Francisco, wrote with colleagues. “Urine-based biomarkers are promising in light of their easy collection, relationship to the pathologic sites of interest and consistent associations with important clinical outcomes.”
In the prospective cohort study, researchers analyzed three cohorts of adults without diabetes or prevalent CKD from the following: Atherosclerosis Risk in Communities, Multi-Ethnic Study of Atherosclerosis and Racial Differences in Stroke.
The goal was to evaluate potential associations of five urinary biomarkers of kidney tubulointerstitial health with incident CKD, independent of traditional measures of kidney health, in patients with an eGFR of at least 60 mL/min/1.73 m2 and without diabetes.
Data from 872 patients in the Atherosclerosis Risk in Communities cohort, 636 patients in Multi-Ethnic Study of Atherosclerosis and 924 patients in Reasons for Geographic and Racial Differences in Stroke were used. Main outcomes were incident CKD or end-stage kidney disease.
Higher concentrations of urine monocyte chemoattractant protein-1, alpha-1-microglobulin and kidney injury molecule-1 were associated with incident CKD in the first group, according to the study results. Higher urine monocyte chemoattractant protein-1 levels and lower epidermal growth factor were linked to incident CKD in the second group. None of the biomarkers showed an association with incident CKD in the final group of patients.
A meta-analysis of all three groups showed a twofold increase in alpha-1-microglobulin concentration was linked to incident CKD, according to Amatruda and colleagues, suggesting higher baseline levels of urine alpha-1-microglobulin were tied to incident CKD at follow-up, according to the study. Four biomarkers were linked to incident CKD in at least one cohort when analyzed individually.
“This insight raises the possibility that kidney tubule biomarkers could identify early tubulointerstitial disease, allowing clinicians to investigate potential causes and institute therapies at actionable stages, before the accumulation of substantial damage and evident glomerular filtration rate loss,” the researchers wrote. “Future studies should continue to evaluate kidney tubule biomarkers in younger and healthier populations, document changes over time and determine whether the damage represented by urine biomarkers is therapeutically actionable.”
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