A novel integrated biomarker for screening diabetic kidney diseases: Critical shear stress of RBCs

Abstract

Many studies have demonstrated that an alteration in hemorheological properties is correlated with diabetic microcirculatory diseases. However, most of these studies have been limited to animal studies or used a small number of clinical samples, due to a lack of point-of-care (POC) devices to measure such properties within clinical environments. Owing to our development of the microfluidic device (RheoScan system) as a POC device, one can easily measure RBC deformability and critical shear stress at any clinical environments. With the RheoScan system, we have conducted extensive clinical studies for more than 10- years to investigate whether any hemorheological properties can be used as diagnostic indexes for diabetic complications including retinopathy as well as nephropathy. After all, we found that the critical shear stress, as a measure of RBC aggregation force, was strongly correlated with two independent diagnosticindexes of albumin to urine creatinine ratio (uACR) and glomerular filtration rate (GFR) for chronic kidney disease (CKD). With the heat map of CKD using ACR and GFR, CSS can show the high sensitivity and specificity for orange zone (moderately) as well as red zone (severely). Therefore, CSS could be a novel integrated biomarker for screening diabetic kidney diseases considering both ACR and GFR.