For over 70 years, serum creatinine has remained the primary index for detection and monitoring of kidney disease. Tubulo-interstitial damage and fibrosis are highly prognostic for subsequent kidney failure in biopsy studies, yet this pathology is invisible to the clinician in the absence of a biopsy. Recent discovery of biomarkers that reflect distinct aspects of kidney tubule disease have led to investigations of whether these markers can provide additional information on risk of CKD progression and associated adverse clinical endpoints, above and beyond eGFR and albuminuria. These biomarkers can be loosely grouped into those that mark tubule cell injury (e.g. KIM-1, MCP-1), and those that mark tubule cell dysfunction (e.g. α1M, UMOD). These kidney tubule biomarkers provide new opportunities to monitor response to therapeutics used to treat CKD patients. In this review, we describe results from some unique contributions in this area, and discuss current challenges and requirements in the field to bring these markers to clinical practice. We advocate for a broader assessment of kidney health that moves beyond a focus on the glomerulus, and we highlight how such tools can improve diagnostic accuracy and earlier assessment of therapeutic efficacy or harm in CKD patients.
Copyright © 2021. Published by Elsevier Inc.