Urinary Proteomics and Precision Medicine for Chronic Kidney Disease: Current Status and Future Perspectives

Abstract

Precision medicine is since long an ongoing refinement of classical medicine, integrating improved and more detailed pathophysiological understanding with rapid technological advances. In the heterogenous area of chronic kidney disease there seems to be a high potential for the improvement in treatment and prognosis for several causes, with new technologies under development, that are yet to be introduced in clinical practice. As in other medical disciplines, investigation of abundant peptide patterns (proteomics) has gained recent interest. Especially relevant for kidney disease, urinary proteomics may provide both improved diagnosis and, as reviewed here, also holds promise for personalized treatment in the future. So far, capillary electrophoresis coupled to mass spectrometry (CE-MS) is the most widely applied technique, and in addition to several cross-sectional and cohort studies, there is even an ongoing randomized controlled trial that will soon report on the concept used as a method of personalizing treatment. In addition, there is hope that urinary proteomics can turn into a "liquid biopsy," replacing the invasive diagnostic procedure. The next couple of years will provide more answers on the topic.

Urinary Peptidomic Biomarkers in Kidney Diseases

“…In conclusion, urinary proteomics is one such promising technology that could help to personalize treatment in patients suffering from kidney disease [6], though its translation into day-to-day practice is lagging behind. Recent technical advances as well as certain current and projected ventures, may ultimately clinch the use of urinary peptidomics in the near future as a major part of kidney disease management.…”

“…Moreover, proteins are the major drug targets. Thus, urinary proteomics has been applied extensively these last several years, with a view to identifying markers of kidney disease progression, diagnosis, or responsiveness to therapy [2,4,[6][7][8].…”

Proteomics for Clinical Assessment of Kidney Disease

“…As an example, laser dissection mass spectrometry is currently the best available option to characterize the nature of glomerular amyloidosis, a requirement for etiology‐targeted therapy . In this issue of PROTEOMICS—Clinical Applications, four manuscripts explore different aspects of clinical proteomics in the context of AKI, CKD, and kidney transplantation from a diagnostic and risk stratification point of view . In this regard, another major application of proteomics to kidney research, the identification of novel pathogenic pathways, is not specifically addressed …”

“…Persson and Rossing explore urinary proteomics in human CKD . Specifically, they focus on urinary proteomics using capillary electrophoresis coupled to mass spectrometry (CE‐MS), a technique used to develop the CKD273 urine proteomics classifier.…”

Clinical Proteomics on the Path Toward Implementation: First Promises Delivered

“…An important focus in clinical proteomics is the applications in chronic kidney disease . This may in part be due to the availability of urine as an easily accessible specimen depicting kidney pathophysiology, but also a result of the enormous impact of kidney disease on health and economics .…”