Make room, cholesterol. A new disease marker is entering the medical lexicon: suPAR, or soluble urokinase-type plasminogen activator receptor. A study in the New England Journal of Medicine shows that suPAR, a circulating protein measured by a simple blood test, can reliably predict a person's chances of developing chronic kidney disease as much as five years before this common killer starts causing damage.

The New England Journal of Medicine article appears in Online First, November 5, 2015 to coincide with the American Society of Nephrology's Kidney Week meeting. It will also appear in the printed issue of the journal on November 12.

"SuPAR promises to do for kidney disease what cholesterol has done for cardiovascular disease," said Jochen Reiser, MD, PhD, senior author of the NEJM study and the Ralph C. Brown MD Professor and Chairman of Medicine, Rush University Medical Center. Four other medical institutions collaborated with Rush on the paper: Emory Clinical Cardiovascular Research Institute, Massachusetts General Hospital and Harvard Medical School, NYU Langone Medical Center, and John H. Stroger, Jr. Hospital of Cook County.

Reiser believes that in the near future, high suPAR levels probably will inform physician-patient conversations about preventing kidney disease, just as high cholesterol levels signal the need for lifestyle changes and protective drugs, such as statins, to avert heart attacks and strokes.

The rigorous NEJM study is a significant breakthrough in preventive medicine. Earlier observations by Reiser and his laboratory suggested a role for suPAR in causing the kidney disease known as Focal and Segmental Glomerulosclerosis (kidney scarring). While additional research is needed, the new results indicate a far more broader role for suPAR across all of chronic kidney disease and thus have major public health implications.

More than 15 percent of people in the U.S. have chronic kidney disease, and approximately four percent require dialysis and/or a kidney transplant due to kidney failure. In addition to reducing unnecessary deaths and improving quality of life, a significant decrease in kidney disease incidence would dramatically cut healthcare spending. In 2012, Medicare alone spent $87 billion on medical care provided to patients with chronic and end-stage kidney disease.

http://www.eurekalert.org/pub_releases/2015-11/rumc-ewf102915.php