Non-Invasive Biomarkers for Diagnosis, Risk Prediction, and Therapy Guidance of Glomerular Kidney Diseases: A Comprehensive Review

Essential role of kidney biopsy in diagnosing glomerular diseases amidst evolving biomarkers

The discussion on renal biopsies and biomarkers highlights the essential aspects of nephrology. Although novel diagnostic biomarkers are emerging, renal biopsy remains critical for accurate diagnosis and treatment owing to the lack of sufficiently validated biomarkers with high sensitivity and specificity. Puspitasari et al highlighted the significant changes in renal biopsy indications and histological outcomes before and after the coronavirus disease 2019 (COVID-19) pandemic, reflecting the complex interactions between clinical workflows, public health issues, and patient demographics. Although biomarkers are increasingly utilized in nephrology, their importance remains balanced with traditional practices. Advancements in precision medicine are exemplified by tests like plasma anti-phospholipase A2 receptor levels. However, the COVID-19 pandemic revealed significant vulnerabilities in nephrology services, emphasizing the necessity for adaptable and robust healthcare strategies to manage chronic conditions during global crises. In conclusion, while biomarkers are poised to assume a more prominent role in nephrology, the significance of renal biopsies and thorough histopathological analysis remains paramount in understanding complex disease processes and guiding personalized patient management. The ongoing integration of traditional diagnostic approaches with innovative biomarker strategies promises to improve patient care and long-term health outcomes.

An Updated Comprehensive Review on Diseases Associated with Nephrotic Syndromes

There have been exciting advances in our knowledge of primary glomerular diseases and nephrotic syndromes in recent years. Beyond the histological pattern from renal biopsy, more precise phenotyping of the diseases and the use of modern nephrogenetics helps to improve treatment decisions and sometimes also avoid unnecessary exposure to potentially toxic immunosuppression. New biomarkers have led to easier and more accurate diagnoses and more targeted therapeutic decisions. The treatment landscape is becoming wider with a pipeline of promising new therapeutic agents with more sophisticated approaches. This review focuses on all aspects of entities that are associated with nephrotic syndromes with updated information on recent advances in each field. This includes podocytopathies (focal segmental glomerulosclerosis and minimal-change disease), membranous nephropathy, membranoproliferative glomerulonephritis, IgA nephropathy, fibrillary glomerulonephritis, amyloidosis, and monoclonal gammopathy of renal significance in the context of the nephrotic syndrome, but also renal involvement in systemic diseases, diabetic nephropathy, and drugs that are associated with nephrotic syndromes.