SUMMARY
In the last two decades, information has been sought to complement the gaps in the pathophysiology of chronicCKD-MBD, which has contributed to the discovery of new biomarkers. Their use in clinical practice is being studied intensively. These markers include fibroblast growth factor 23 (FGF23), klotho, sclerostin, and more recently microRNAs.
FGF23 levels rise before changes in calcium, phosphorus, and PTH concentrations, immediately after minor renal impairment, and then several times at further progression of renal impairment. Therefore, affecting levels of FGF23 as a therapeutic target may be one of the promising pathways for these patients in the future. The high expression of klotho as a co-receptor for FGF23 directly regulates the excretion of calcium and phosphorus in the kidney and is involved in the maintenance of mineral homeostasis by regulating 1-alpha-hydroxylase activity, PTH and FGF23 secretion. Next, excretion of sclerostin in CKD is increased. Some research suggests that increased bone turnover and calcified vessel synthesis could cause increased sclerostin levels. It is therefore considered a negative regulator of bone growth. MicroRNA (miRNA, miR) is a single-stranded non-coding RNA and is a promising biomarker for early disease detection and progression as well as treatment target. Those miRNAs that are described as important in the regulation of bone metabolism are likely to be involved in CKD-MBD both in pathological processes in bone and in vascular calcifications. There are several types of miRNAs that have been described as a marker of bone cell differentiation and subsequent mineralization. However, further studies are needed to confirm and correlate these claims with early symptoms, outcomes and treatment in CKD patients.
Key words: chronic kidney disease (CKD), fibroblast growth factor (FGF23), klotho, sclerostin, miRNA, bone turnover.
Lek Obz, 2020, 69 (9): 341-346
Zuzana KUŽMOVÁ, Martin KUŽMA, Ján KYSELOVIČ, Juraj PAYER
V. interná klinika LF UK a UNB, Bratislava, prednosta prof. MUDr. J. Payer, PhD., MPH, FRCP
Zuzana KUŽMOVÁ, Martin KUŽMA, Ján KYSELOVIČ, Juraj PAYER: Selected novel biomarkers of chronic kidney disease – metabolic bone disorder.
