Department of Internal Medicine, Indiana University School of Medicine, Royal Oak, MI, USA.
Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA.
Int Urol Nephrol. 2019 Nov;51(11):1893-1902. doi: 10.1007/s11255-019-02231-0. Epub 2019 Aug 5.
Despite rapid advances in diagnostic and therapeutic medicine, renal cell carcinoma (RCC) continues to cause significant morbidity and mortality in patients. While there has been a shift towards earlier detection, approximately 16% of patients present with metastatic disease at the time of diagnosis. Kidney injury molecule-1 (KIM-1) is a glycoprotein that has been shown to be a robust and reliable biomarker of acute proximal tubular injury. As KIM-1 is mainly expressed in RCC derived from the proximal tubules, it is a reliable marker to differentiate between proximal tubular primary RCC and distal nephron primary RCC. Several studies have investigated urinary KIM-1 (uKIM-1) in RCC and demonstrated that it is a sensitive and specific marker for detecting localized RCC, as patients had markedly reduced uKIM-1 levels following nephrectomy, with uKIM-1 levels correlating with tumor size and grade. In addition, levels of KIM-1 present in plasma have also shown utility as a biomarker of RCC with levels being elevated in RCC cases at least 5 years before diagnosis. This review focuses on a progressive understanding of KIM-1 in the diagnosis of RCC using biopsies, urine, and plasma samples, and it will also provide some insight into potential roles of KIM-1 in the growth and spread of RCC.
尽管诊断和治疗医学取得了快速进展，但肾细胞癌 (RCC) 仍在导致患者出现重大发病率和死亡率。尽管已经转向早期检测，但大约 16%的患者在诊断时已经出现转移性疾病。肾损伤分子-1 (KIM-1) 是一种糖蛋白，已被证明是急性近端肾小管损伤的可靠生物标志物。由于 KIM-1 主要在源自近端小管的 RCC 中表达，因此它是区分近端小管原发性 RCC 和远侧肾单位原发性 RCC 的可靠标志物。几项研究调查了 RCC 中的尿 KIM-1 (uKIM-1)，并证明它是检测局限性 RCC 的敏感和特异性标志物，因为患者在肾切除术后 uKIM-1 水平明显降低，uKIM-1 水平与肿瘤大小和分级相关。此外，血浆中存在的 KIM-1 水平也显示出作为 RCC 标志物的效用，其在 RCC 病例中的水平在诊断前至少 5 年就升高了。这篇综述重点介绍了使用活检、尿液和血浆样本诊断 RCC 中 KIM-1 的逐步理解，还将提供一些关于 KIM-1 在 RCC 生长和扩散中的潜在作用的见解。
