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[Biomarkers in diagnosis of kidney diseases caused by chemical toxins].

As yet there has been no evidence produced that nephrotoxic chemicals damage nephron in sites, characteristic of a given toxin. A number of nephrotoxic effects result rather from changes induced by these substances mostly in the peripheral circulatory system than from a direct effect of chemical toxin on the kidneys. In many cases the morbid process in the kidneys does not emerge until a considerable number of nephrons is already damaged. Therefore, it is essential that doctors, attending patients exposed to nephrotoxins, have at their disposal, during periodical examinations, appropriate laboratory tests (biomarkers) able to detect subclinical forms of chemical damage of the kidneys. These biomarkers should also help to identify which of the functional parts of the kidneys have been damaged. It seems that determination of protein excreted with urine is one of the best biomarkers most frequently used to detect the dysfunction of renal glomerulus. It is recommended that the relationship between urine concentration of total protein and urine concentration of creatinine be determined. In the group of biomarkers of tubule dysfunction the measurement of substances usually reabsorbed from glomal filtrate (low-molecular protein) in proximal tubule or determination of enzymes' activity in urine (e.g. N-acetylo-glucosoaminidase) and those cellular components which are not excreted with normal urine are recommended. In the assessment of distal renal tubule dysfunction it is advised to examine urine osmolarity and/or determination of Thamm-Horsfall glycoprotein.