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Urinary biomarkers of IgA nephropathy and other IgA-associated renal diseases

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Abstract

IgA nephropathy is the most common primary glomerulonephritis and is a frequent cause for chronic kidney disease in children and young adults. Glomerular deposition of IgA also characterizes other renal disorders, including Henoch-Schoenlein purpura nephritis and immune-complex glomerulonephritis afflicting patients with liver disease due to chronic infection with the hepatitis C virus. Several treatment options are often considered, with the goal to prevent end-stage renal failure. Unfortunately, the diagnosis currently requires an invasive procedure, a renal biopsy. Because of the inherent risks, repetitive renal biopsy is frequently foregone as a means to monitor the clinical course or response to treatment. Recent advances in the analysis of the urinary proteome suggest that the excreted polypeptides include disease-specific patterns. We review recent studies of the various techniques for the identification and validation of such urinary biomarkers of IgA-associated glomerulonephritides. Currently, capillary electrophoresis coupled with mass spectrometry (MS) offers the greatest promise. To date, it seems more likely that disease-specific urinary polypeptide biomarkers are comprised of a panel of several distinct and well-defined peptides rather than a single molecule. Even most patients in clinical remission with normal clinical testing (dipstick urinalysis and quantitative proteinuria) were correctly classified by the pattern of polypeptides identified by capillary electrophoresis coupled with MS. With confirmation and refinement, such urinary testing may provide a tool for the diagnosis and monitoring of patients with IgA-associated renal diseases that is more sensitive than current standard clinical testing and far less risky than renal biopsy.

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Acknowledgments

This work was supported by grants DK61525, DK71802, DK78244, and DK64400 from the National Institutes of Health and by General Clinical Research Center of the University of Alabama at Birmingham (M01 RR00032).

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Authors and Affiliations

  1. Department of Medicine, University of Alabama at Birmingham, 1530 Third Avenue South, Birmingham, AL, 35294, USA

    Bruce A. Julian & Brendan M. McGuire

  2. Mosaiques Diagnostics and Therapeutics AG, Hannover, Germany

    Stefan Wittke, Petra Zürbig & Eric Schiffer

  3. Medical School Hannover, Hannover, Germany

    Marion Haubitz

  4. Health Sciences Center and Children’s Foundation Research Center, University of Tennessee, 50 N. Dunlap Avenue Room 301, West Patient Tower, Memphis, TN, 38103, USA

    Robert J. Wyatt

  5. Department of Microbiology, University of Alabama at Birmingham, 1530 Third Avenue South, Birmingham, AL, 35294, USA

    Jan Novak

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  1. Bruce A. Julian
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Correspondence to Bruce A. Julian.

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Julian, B.A., Wittke, S., Haubitz, M. et al. Urinary biomarkers of IgA nephropathy and other IgA-associated renal diseases. World J Urol 25, 467–476 (2007). https://doi.org/10.1007/s00345-007-0192-5

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