Madariaga Leire, Ferrulli Angela, García-Alonso Marta
Pediatric Nephrology Department, CIBERDEM/CIBERER/Endo-ERN, Biobizkaia Health Research Institute, University of the Basque Country, Cruces University Hospital, Plaza de Cruces S/N, Barakaldo, 48903, Spain.
Genomics and Proteomics Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Bari, Italy.
Pediatr Nephrol. 2025 Sep 9. doi: 10.1007/s00467-025-06941-9.
Copeptin, a stable glycopeptide derived from the precursor of arginine vasopressin (AVP), has emerged as a valuable surrogate biomarker for AVP due to its stability and ease of measurement. This narrative review explores the physiological role of copeptin, its utility as a diagnostic and prognostic biomarker in different kidney diseases, and its clinical relevance in renal tubular disorders. The clinical application of copeptin as a diagnostic biomarker is best established in the differential diagnosis of polyuria-polydipsia syndrome (PPS), distinguishing nephrogenic diabetes insipidus (NDI) from central diabetes insipidus (CDI) and primary polydipsia (PP). Baseline and stimulated copeptin levels demonstrate high diagnostic accuracy, although methodological and population-specific limitations exist, especially in pediatrics. Copeptin has also proved to be a marker of disease severity in a wide range of acute pathologies. In chronic kidney disease (CKD), it correlates negatively with kidney function, and it has been shown to be a marker of kidney function decline in kidney transplant patients and in autosomal dominant polycystic kidney disease (ADPKD). Regarding renal tubular disorders, CKD has increasingly been recognized in these patients, potentially driven by persistent volume depletion and activation of the renin-angiotensin-aldosterone system. Copeptin may offer an objective assessment of volume status and disease severity, particularly in infants and young children. However, further studies are needed to define standardized reference values, clarify its mechanistic role, and validate its prognostic utility in tubulopathies. Copeptin holds potential as both a diagnostic and prognostic biomarker in renal tubular disease, with implications for clinical practice and patient management.
copeptin是一种从精氨酸加压素（AVP）前体衍生而来的稳定糖肽，由于其稳定性和易于测量，已成为AVP的一种有价值的替代生物标志物。本叙述性综述探讨了copeptin的生理作用、其作为不同肾脏疾病诊断和预后生物标志物的效用以及其在肾小管疾病中的临床相关性。copeptin作为诊断生物标志物的临床应用在多尿-多饮综合征（PPS）的鉴别诊断中最为明确，可区分肾性尿崩症（NDI）与中枢性尿崩症（CDI）及原发性烦渴（PP）。尽管存在方法学和人群特异性限制，尤其是在儿科，但基线和刺激后的copeptin水平显示出较高的诊断准确性。copeptin在多种急性疾病中也被证明是疾病严重程度的标志物。在慢性肾脏病（CKD）中，它与肾功能呈负相关，并且已被证明是肾移植患者和常染色体显性多囊肾病（ADPKD）中肾功能下降的标志物。关于肾小管疾病，这些患者中CKD的认识日益增加，可能是由持续的容量耗竭和肾素-血管紧张素-醛固酮系统的激活所驱动。copeptin可能提供对容量状态和疾病严重程度的客观评估，特别是在婴幼儿中。然而，需要进一步研究来确定标准化参考值、阐明其机制作用并验证其在肾小管疾病中的预后效用。copeptin在肾小管疾病中作为诊断和预后生物标志物具有潜力，对临床实践和患者管理具有重要意义。
