title: Pro: 'The usefulness of biomarkers in glomerular diseases'. The problem: moving from syndrome to mechanism--individual patient variability in disease presentation, course and response to therapy.
abstract: The diagnosis and treatment decisions in glomerular disease are principally based on renal pathology and nonspecific clinical laboratory measurements such as serum creatinine and urine protein. Using these classification approaches, patients have marked variability in rate of progression and response to therapy, exposing a significant number of patients to toxicity without benefit. Additionally, clinical trials are at risk of not being able to detect an efficacious therapy in relevant subgroups as patients with shared clinical-pathologic diagnoses have heterogeneous underlying pathobiology. To change this treatment paradigm, biomarkers that reflect the molecular mechanisms underlying the clinical-pathologic diagnoses are needed. Recent progress to identify such biomarkers has been aided by advances in molecular profiling, large-scale data generation and multi-scalar data integration, including prospectively collected clinical data. This article reviews the evolving success stories in glomerular disease biomarkers across the genotype-phenotype continuum and highlights opportunities to transition to precision medicine in glomerular disease.
authors.affiliation: Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Mariani
authors.affiliation: Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kretzler
mesh_terms: D015415:Biomarkers / Q000097:blood*; D018450:Disease Progression; D056726:Genetic Association Studies; D006801:Humans; D007674:Kidney Diseases / Q000145:classification* / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy; D007677:Kidney Function Tests; D007678:Kidney Glomerulus / Q000473:pathology*; D058990:Molecular Targeted Therapy; D057285:Precision Medicine; D013577:Syndrome
chemical_list: D015415:Biomarkers
keywords: molecular taxonomy; nephrotic syndrome; precision medicine; translational medicine