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IntroductionA chronic interstitial disease, chronic kidney disease of uncertain etiology (CKDu) has emerged as a notable contributor to the CKD burden in rural Sri Lanka. Most therapeutic and diagnostic approaches of CKD are focusing towards glomerular diseases, thus not fully applicable to CKDu. Serum proteins, specifically profile of markers representing different facets of a disease are rewarding in a comprehensive evaluation of a disease, hence in CKD. Our aim is to identify the role of serum retinol binding protein 4 (RBP4), a marker of proximal tubular in the diagnosis of CKDu.MethodsDefinite CKDu cases were recruited from the renal clinic, Girandurukotte & Wilgamuwa (endemic regions). Healthy controls were recruited from Mandaramnuwara (non-endemic area). The levels of RBP4 and creatinine in serum were measured. An immunoassay (ELISA) on the serum samples were performed. The stages of CKD/ CKDu were classified according to eGFR. ResultsSerum RBP4 was significantly increased in CKDu compared to CKD and healthy controls. The results showed that normalized serum RBP4 to serum creatine (S.cr) acts as competitive marker for CKDu (AUC 0.762, sensitivity 0.733) than CKD (AUC 0.584, sensitivity 0.733) when compared against healthy controls. Furthermore, RBP4:S.cr ratio showed higher discriminating power (AUC 0.743) between CKDu and CKD, suggesting RBP4: S.cr ratio as potential serum marker to differentiate CKDu from CKDu.ConclusionRBP4: S.cr ratio was identified as a plausible indicator for differentiating CKDu from CKD with >70% sensitivity and specificity. Therefore, it could be used in the evaluation of tubular interstitial involvement of CKD. |
