Review Article

Renal Biopsy: Use of Biomarkers as a Tool for the Diagnosis of Focal Segmental Glomerulosclerosis

Table 1

The potential use of different biomarkers on FSGS diagnosis.

BiomarkerSpeciesActivityReference

Soluble urokinase-type plasminogen
activator receptor (SuPAR)
HumanElevated levels in the plasma of primary FSGS patients and in plasma and urine of transplanted patients with recurrent FSGS[2325]
Still inconclusive for primary FSGS diagnosis in children[26]
MiceCauses foot process effacement, proteinuria, and FSGS-like glomerulopathy by direct activation of podocyte integrins[16, 27]

Cardiotrophin-like cytokine
factor 1 (CLC-1 )
HumanElevated plasma levels in patients with recurrent FSGS, mimicking the effects of FSGS plasma on Palb. Anti-CLC-1- specific monoclonal antibody blocks the Palb effect of active FSGS sera[4, 13]

Transforming growth factor-beta
(TGF- )
HumanCirculating plasma levels correlated with other biomarkers in patients with diverse glomerulopathies[28]
Increased renal expression in children with FSGS[29]
Increased expression of the protein, its receptor, and associated signalling proteins in podocytes of FSGS patients[30]
In situ expression is associated with changes in extracellular matrix and podocyte apoptosis[31]
MiceInduces podocyte apoptosis[32]

Malondialdehyde HumanPotent marker of oxidative stress-induced lipid peroxidation used in several acute and chronic kidney diseases in adults and children[3335]
Elevated urine and serum levels associated with glomerular overexpression in patients with FSGS[36, 37]
MiceAssociated with reactive oxygen species overproduction in animal glomeruli mimicking human FSGS[38]

Dystroglycan HumanDifferential expression between MCD and FSGS patients[39]
Increased expression in FSGS compared to MDC renal biopsies[40]
RatServes as matrix anchor to the glomerular filtration membrane[41]

Transient receptor potential cation
channel 6 (TRP6)  
HumanFundamental component of the glomerular basement membrane. Gene mutations cause inherited glomerular diseases such as FSGS[42, 43]

MicroRNAs 
(miR-192 and miR-205)
HumanHigher serum levels in primary FSGS than MCD patients. They correlate with the degree of interstitial fibrosis in FSGS[44]
RatThey are mainly expressed in the renal cortex[45]

Metalloproteinases (MMP-2 and MMP-9) and Tissue inhibitors of metalloproteinases
(TIMPs)
HumanElevated plasma levels associated with kidney allograft survival[46]
Circulating plasma levels correlated with other biomarkers in patients with diverse glomerulopathies[28]
MiceDecreased expression in the kidneys of mice presenting glomerulonephritis[47]
RatReduced expression was associated with fibronectin deposition in FSGS injured glomeruli[48]


Human neutrophil gelatinase-associated
lipocalin (NGAL)
Human Increase in urine and kidney cortical tubules of patients with acute renal failure[4951]
Elevated levels in the urine from children with FSGS, presenting positive correlation with urinary protein excretion but negative correlation with estimated creatinine clearance at disease diagnosis[52]