Good Thing I Didn’t Get a Kidney Biopsy! The Next Generation: Liquid Biopsy is Here!

During my hospital rounds and patient discussions I have noticed that the feeling among kidney patients is changing. They mostly say:
“Thank goodness I didn’t get a kidney biopsy!”
This feeling comes from the change of an exceptionally good diagnostic method:
LIQUID BIOPSY

One of the “Top 10 Breakthrough Technologies in 2015” by MIT, liquid biopsy is a new technique that can significantly impact the lives of chronic kidney disease (CKD) patients.

THE DEFINITION OF LIQUID BIOPSY

The standard kidney biopsy is the removal of kidney tissue (a complicated, moderately dangerous operation, which requires a hospital stay) whereas the newer liquid biopsy test measures different biomarkers in:

• blood
• urine
• any other body fluids
  Features:
  ✔ No risk
  ✔ Low cost

✔ Completely new mechanisms (as Creatinine helps only after damage is done)

NEED OF BIOPSY MARKERS IN NEPHROLOGY

1. Blood Test for Anti-PLA2R Antibodies

• About 70-80% of membranous nephropathy cases can be identified with this test.
• Very high specificity of 99-100%: a positive result is equal to membranous nephropathy.
• Eliminates the need to have a biopsy in most cases
  Recommended for adults with nephrotic syndrome

2. Kidney Injury Molecule-1 (KIM-1, Urine Test)

• Affected renal tubules secrete it
• Points to reversible kidney injury
• Only recently introduced in clinical practice (2022)

3. Podocytes (Urine Test)

• These glomerular cells are the main barrier to protein leakage
• A new study indicates the correlation of podocyte depletion with:
  → Hypertension
  → Serum lipid values
  (Not with blood sugar/proteinuria directly)
• Accounts for the reason that diabetes treatment alone may not completely halt the progression of renal failure

4. Exosomes (Multiple Fluids)

The small vesicles packed with microRNAs (miRNAs) are the sources of highly specific kidney damage:

• Lupus nephritis: miR-21, miR-150
• IgA nephropathy: miR-555, miR-204
• Minimal change disease: miR-1225-5p

– Membranous nephropathy: Ceruloplasmin

Why This Matters for US Patients

1. Prevents biopsy risk (bleeding, infection, hospitalization)
2. Detects causes amenable to treatment much earlier than creatinine/eGFR
3. Helps to select individualized treatment (for example, immune vs. metabolic damage)
4. Treatment monitoring becomes dynamic
   We are proud to have integrated these groundbreaking tests in our clinic to bring about precision nephrology care. The words of one patient sum up the experience quite well:

“My liquid biopsy was very informative and it was not like any biopsy needle that shockingly gave me very little information.”

About the Author

Dr. Stone

• Chief Physician & Medical Director
• Professional Affiliations:
  → Member, Chinese Society of Nephrology
  → Chair, Renal Acupuncture Therapy Committee
• Research Focus:
  → Non-invasive kidney diagnostics
  → Integrative treatment approaches
  For consultations:
  [WeChat QR code placeholder]

(Note: Original institutional references adapted for US healthcare context. Images retained per original positioning.)

Key Adaptations for American Readers:

1. Medical terms were simplified (e.g., “renal” → “kidney”).
2. Patient-centric benefits were highlighted upfront.
3. New content with clear headers was created for easier reading.
4. Contextual explanations were added for unfamiliar tests in the US.
5. Scientific accuracy was kept while improving the flow of the text.
   The translation keeps all the medical information of the original text but makes it more accessible for English-speaking patients and clinicians.