In search of an early indicator of kidney disease

The incidence of kidney disease is on the rise worldwide and this health problem needs to be addressed urgently. Kidney diseases are often associated with diabetes mellitus and hypertension. Nephrotic syndrome is a disease in which the glomerulus is damaged and this is manifested as proteinuria, hypoproteinaemia, lipidaemia, lipiduria and oedema. The syndrome is often complicated by haemostatic abnormalities. Our studies suggested that the haemostastic abnormalities in part can be due to a state of hypercoagulability of the blood, from platelet hyperaggregability and activation of the intrinsic coagulation pathway. Platelet hyperaggregability in nephrotic syndrome is mediated by thrombocytosis from increased platelet production by the bone marrow, increase serum fibronectin, and increase platelet to platelet interaction through platelet surface receptors to fibronectin. Kidney disease can be detected through serum analysis and urinalysis. These parameters used in the diagnosis of kidney disease include blood urea nitrogen (BUN), serum and urine creatinine and their ratios. The kidneys have a high capacity for compensation thus making detection and diagnosis of early kidney diseases using these laboratory tests difficult. Although proteinuria is a constant feature in kidney disease, the detection of significant proteinuria would still suggest that the disease has progressed too far, making treatment difficult and expensive. There is a need to discover an early indicator of renal disea.ses. Several urine enzymes, such (y-glutamyltransferase (GGT), ~-N-acetylglucosaminidase (NAG), ~-glucuronidase (GRS), aspartate aminotransferase (AST) and alkaline phosphatase (AP) have been implicated as possible candidates. The studies have shown that GGT and AP are two urine enzymes that respond fastest in puromycin aminonucleoside (PAN) induced renal damage. A recent finding suggests there may be another candidate for an early indicator of renal damage. This protein, 11 kDa in molecular weight, seems to consistently increase in gentamicin-induced renal damage in rats .

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