Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Elevated Soluble Urokinase Receptor Levels

A risk factor for chronic kidney disease?

An elevated level of soluble urokinase-type plasminogen activator receptor (suPAR) was independently associated with incident chronic kidney disease and an accelerated decline in the glomerular filtration rate (eGFR) in a study of 3,683 persons who had their plasma suPAR levels measured. Results of the study showed:

• A higher suPAR level at baseline was associated with a greater decline in the eGFR during follow-up.

• 921 participants with a normal eGFR at baseline had the largest suPAR-related decline in the eGFR.

• Risk of progression to chronic kidney disease in the highest quartile of suPAR levels was 3.13 times as high as that in the lowest quartile. (2.11 to 4.65) in 1,335 patients with a baseline eGFR of at least 60 ml per minute per 1.73m2.

Citation: Hayek SS, Sever S, Ko YA, et al. Soluble urokinase receptor and chronic kidney disease. N Engl J Med. 2015;373(20):1916-1925. doi: 10.1056/NEJMoa1506362.

Commentary: Eleven percent of the United States Population has chronic kidney disease (CKD). Typically, early CKD is detected through detection of elevated levels of protein in the urine or through increasing creatinine, indicating decreasing GFR. The discovery of a sensitive biomarker with high predictive value for the development of CKD in individuals may potentially facilitate the discovery of ways to prevent the progression of renal disease early on in its development. —Neil Skolnik, MD