Key result
Lower baseline urinary KIM-1/creatinine values were associated with a more rapid time to complete remission after adjusting for proteinuria, histopathologic diagnosis, and treatment.
Why the study?
Are baseline uKIM-1/cr and uPOSTN/cr levels associated with disease severity and complete remission in patients with glomerular disease?
Cohort
Yes
Are baseline uKIM-1/cr and uPOSTN/cr levels associated with disease severity and complete remission in patients with glomerular disease?
Lower baseline urinary KIM-1 levels are associated with a higher likelihood of complete remission in patients with glomerular disease, suggesting its utility as a prognostic biomarker.
uKIM-1/cr may refine remission risk estimates in proteinuric glomerular disease; leaves open prospective validation before clinical adoption.
INTRODUCTIONS: Kidney injury molecule-1 (KIM-1) and periostin (POSTN) are proximal and distal tubule injury biomarkers. We tested whether baseline urine KIM-1/creatinine (uKIM-1/cr) and/or uPOSTN/cr correlated with disease severity or improved a remission prediction model. METHODS: Baseline uKIM1/cr and uPOSTN/cr were measured on spot urine samples from immunosuppression-free patients enrolled in Nephrotic Syndrome Study Network until December 15, 2014. Urine protein/creatinine (UPCR) and albumin/creatinine (UACR) were measured at baseline, 4 months, and until last follow-up. Glomerular and tubulointerstitial (TI) expression arrays were analyzed from a baseline research renal biopsy core collected during a clinically indicated biopsy.Renal diagnoses were centrally confirmed, sections scanned, and measured morphometrically. Correlations between baseline uKIM-1/cr and uPOSTN/cr and UPCR, UACR, histopathologic features, glomerular and TI KIM-1 and POSTN expression levels, and renal outcomes were assessed. RESULTS: Baseline uKIM-1/cr correlated with UPCR and UACR, and were associated with complete remission after adjustment for proteinuria, histopathologic diagnosis, and treatment. Baseline uKIM-1/cr also correlated with degree of foot process effacement and acute tubular injury. Glomerular and TI KIM-1 expression levels correlated with UPCR and UACR. Higher TI KIM-1 expression levels correlated with interstitial fibrosis, tubular atrophy, and global glomerulosclerosis, while glomerular KIM-1 expression correlated with time to remission. Findings for POSTN were of lesser statistical strength. DISCUSSION/CONCLUSION: Lower baseline uKIM-1/cr values were associated with more rapid time to complete remission after adjusting for proteinuria, histopathologic diagnosis, and treatment. Increased TI KIM-1 expression levels in proteinuric states were associated with chronic morphological injury; lower glomerular expression levels were associated with a greater potential for proteinuria reversibility.
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Wu et al. (2021) conducted a cohort in Glomerular disease. Baseline urine KIM-1/creatinine and periostin levels was evaluated on Complete remission. Lower baseline urinary KIM-1/creatinine values were associated with a more rapid time to complete remission after adjusting for proteinuria, histopathologic diagnosis, and treatment.
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