Renal Biomarkers and Early Kidney Injury in Women with Polycystic Ovary Syndrome: A Narrative Review
Polycystic ovary syndrome, Early kidney injury, Renal biomarkers, Insulin resistance, Microalbuminuria, Tubular injury
AuthorsAbstractPolycystic ovary syndrome (PCOS) has been a highly studied endocrinemetabolic condition in women of reproductive age, which is traditionally known to have reproductive and metabolic effects. There is also emerging evidence that PCOS may also have early renal involvement that may put the affected women at risk of having chronic kidney disease in them later in life. This narrative review will synthesize the existing evidence on pathophysiological connections between PCOS and renal dysfunction, critically assess the limitations of traditional renal biomarkers, and the use of emerging biomarkers in the early detection of kidney damage in women with PCOS. The synergistic effects on the development of subtle glomerulonephritis and tubular damage occur as a result of insulin resistance in PCOS, hyperandrogenism, obesity, persistent low-grade inflammation, oxidative stress, endothelial dysfunction, and reninangiotensin-aldosterone system activation. The traditional renal markers, serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate using creatinine, are commonly insensitive to such early alterations and can be observed to be within normal ranges despite continued stress to the renal system. New biomarkers, such as urinary albumin -to -creatinine ratio, cystatin C, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1, are more sensitive in detecting early glomerular permeability changes, tubular injury, and microvascular dysfunction, in contrast. Risk stratification and targeted interventions in women with PCOS could be achieved by early detection of renal involvement by sensitive biomarkers. The introduction of renal biomarker evaluation as part of the routine clinical evaluation, in combination with lifestyle modification and metabolic optimization, could aid in avoiding the development of overt renal disease. More longitudinal and mechanistic research is needed to confirm these biomarkers and determine their prognostic potential in determining renal outcomes in the long term in PCOS. 1. Introduction Polycystic ovary syndrome (PCOS) is an extremely widespread endocrinemetabolic syndrome among women of reproductive age and is linked with hyperandrogenism, ovulatory impairment, and polycystic ultrasonic appearance of the ovary (1). Besides the reproduction manifestations, PCOS is also becoming increasingly relevant as an overall metabolic disease that is associated with insulin resistance, obesity, dyslipidemia, chronic low-grade inflammation and endothelial dysfunction (2). Such comorbid deformities expose women with PCOS to the risk of cardiometabolic conditions, including hypertension and type 2 diabetes mellitus (3). The renal involvement of PCOS has become a major interest over the last few years, particularly, the danger of early kidney damage as a predisposing factor to the overt chronic kidney disease (CKD) (4). Traditional renal biomarkers, such as serum creatinine and the estimated glomerular filtration rate (eGFR) are not likely to detect the subtle nature of renal impairment (5). Hence, novel renal biomarkers have taken a leading role in the screening of early •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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