肾小球肾病的有效管理,慢性肾脏病(CKD)的主要类别之一,需要准确的诊断,进展的预后,评估治疗效果,and,理想情况下,药物反应的预测。文献中已经报道了用于评估肾小球疾病特定方面的多种生物标志物和算法。不过,其中绝大多数尚未在临床实践中实施,或者由于访问权限有限而无法在全球范围内使用,缺少医疗基础设施,或经济和政治原因。这项审查的目的是汇编目前所有可用的诊断信息,预后,和目前可用于肾小球疾病管理的预测性生物标志物,并为这些生物标志物的应用提供指导。由于收集了可用的不同生物标志物的证据,我们提出了一个非侵入性的决策树,生物标志物指导的诊断路径。目前可用的数据表明,对于大多数肾小球疾病患者,有效的生物标志物是可用的。然而,尽管肾活检有明显的缺点,具有侵入性,不适用于监测,特别是在罕见CKD病因的背景下,肾活检仍不能被非侵入性策略所取代.
Effective management of glomerular kidney disease, one of the main categories of chronic kidney disease (CKD), requires accurate diagnosis, prognosis of progression, assessment of therapeutic efficacy, and, ideally, prediction of drug response. Multiple biomarkers and algorithms for the assessment of specific aspects of glomerular diseases have been reported in the literature. Though, the vast majority of these have not been implemented in clinical practice or are not available on a global scale due to limited access, missing medical infrastructure, or economical as well as political reasons. The aim of this review is to compile all currently available information on the diagnostic, prognostic, and predictive biomarkers currently available for the management of glomerular diseases, and provide guidance on the application of these biomarkers. As a result of the compiled evidence for the different biomarkers available, we present a decision tree for a non-invasive, biomarker-guided diagnostic path. The data currently available demonstrate that for the large majority of patients with glomerular diseases, valid biomarkers are available. However, despite the obvious disadvantages of kidney biopsy, being invasive and not applicable for monitoring, especially in the context of rare CKD etiologies, kidney biopsy still cannot be replaced by non-invasive strategies.