URINE TEST - April 2010

Researchers Discovered a New Urine Test for Diagnosing Early Kidney Cancer

Published April 18, 2010

Elevated Detection of Two Proteins Identify 90% of All Kidney Cancers

In 2009, 57,600 people (35,430 men & 22,330 Women) in the United States diagnosed with kidney cancer. In the same year, National Cancer Institute reported 11,033 kidney cancer deaths.

Most Kidney cancer patients 60 - 80 years old. "The cause of kidney cancer is unknown." 1 Majority of kidney cancers (80%) diagnosed during a CT scan or ultrasound test, when a physician orders the test for unrelated stomach discomfort. When kidney cancer is diagnosed early, treatment is more successful for a full recovery. Researchers reported in 2009, a new urine test for diagnosing kidney cancer, especially in the early stage, when recovery is more favorable. Also, the test verifies the absent of tumors removed from kidneys by measuring the levels of two proteins.

Two kidneys in the human body, located just below the rib cage, middle of the back and one on each side of the spine are vital organs: Keep blood clean and maintain normal chemical balance in the body. The anatomy of the kidney has millions of nephrons: "Its chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest in urine (Excess amount of fluid and wastes pass through ducks leading to the ureter and bladder as urine). " Also, kidney's function to produce two important hormones (Erythropoetin and Renin). The production of Erythropoetin informs the bone marrow to make more red blood cells (carry oxygen in the blood), when less oxygen is detected. Kidneys produce Renin hormone during exercise, stress, low blood pressure and reduction in blood flow. The hormone functions to increase sodium and maintain normal plasma volume. "Overproduction of renin can cause hypertension." When kidneys fail to function normally, dialysis or artificial replacement is necessary, remove waste products and excess fluids from the bloodstream, as well maintain normal chemical balance in the blood. Excess amount of water is excreted through urine by the function of the kidney. Less than normal urine output is linked to dehydration.

Two most common types of kidney cancer: Renal Cell Cancer (Ninety percent begin in the lining of the renal tubules in the kidney, where blood is filtered and produce urine.) and transitional cell cancer (Least common
kidney cancer, stem from the cells lining the kidney). Currently 80 percent of diagnosed kidney cancer patients die within the first two years and more than 95 percent die within five years, result of the cancer metastasizes to other organs (The fourth and final stage of diagnosed cancer 10).

Early detection of kidney cancer would save more lives, starting treatment sooner. "People with kidney cancer may have surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy. Some may have a combination of treatments."

Mayo Clinic Proceedings published online in May 2010, researchers at Washington University of Medicine in St. Louis describe identifying a pair of elevated (large amounts) measurements of proteins (Aquaaporin-1 (AQP1) and Adipophilin (ADFP)) among selected urine secreted samples (Total of 42 urine samples examined, including patients diagnosed with kidney disease, non-cancer surgical patients, and healthy volunteers), 90 percent accurately linked to kidney cancers. The absent of elevated AQP1 and ADFP proteins: Among clinical patients who are healthy or patients tested prior to non-cancer surgery. When kidney cancer tumors are removed, levels of these proteins where no longer detected in urine samples or declined rapidly. Co-Researcher Jeremiah J. Morrisssey, PHD said: "Screening patients to find kidney cancer when it is still small and treatable could save a number of lives and preserve kidney function in many people. It also may represent the difference between losing an entire kidney or extracting only a tumor while sparing healthy portions of the organ." Further tests will determine if elevated protein levels (AQP1 and ADFP) present in other types of kidney diseases. Also, establishing a correlation between levels of proteins detected to the actual size of the kidney tumors.

Investigators Morrissey and Evan D. Kharasch, MD, PHD that discovered the proteins Aquaaporin-1 and Adipophilin filed a patent use application, through Washington University's Office of Technology Management.

When the Food and Drug Administration approves urine test screening for the proteins Aquaaporin-1 and Adipophilin for kidney cancer, during a routine doctor's visit or health check-up: More lives could be saved by
starting treatment early, especially when kidney cancer is detected sooner, besides health cost savings. When elevated levels of the proteins are not detected, a kidney biopsy may not be necessary.

====== SAME INFO AGAIN ====

A Step Closer To Developing A Urine Test For Kidney Cancer

Main Category: Cancer / Oncology

Also Included In: Urology / Nephrology; Medical Devices / Diagnostics

Article Date: 09 Apr 2010 - 0:00 PDT

Studying patients with kidney cancer, a team of researchers at Washington University School of Medicine in St. Louis has identified a pair of proteins excreted in the urine that could lead to earlier and more accurate diagnosis of the disease.

The research, published online in the May issue of Mayo Clinic Proceedings, is the first to identify proteins secreted in urine that appear to accurately reveal the presence of about 90 percent of all kidney cancers.

Currently, there is no diagnostic test for kidney cancer. About 80 percent of kidney tumors are discovered incidentally, during a CT scan or ultrasound test that has been ordered for an unrelated abdominal complaint.

"Kidney cancer is a silent and frequently fatal cancer," says principal investigator Evan D. Kharasch, MD, PhD. "More than 80 percent of patients die within two years of diagnosis, and more than 95 percent die within five years because by the time the cancer is detected, it often has spread beyond the kidney. When it is identified early, however, kidney cancer is curable in a very high percentage of individuals."

Kharasch and co-investigator Jeremiah J. Morrissey, PhD, looked at urine samples from 42 patients who became aware that they had kidney cancer during an abdominal imaging test and from 15 individuals who did not have cancer but were scheduled for surgery. Another 19 healthy volunteers were included who were not having surgery of any kind.

The researchers focused on two proteins that previously had been found in kidney tumors: aquaporin-1 (AQP1) and adipophilin (ADFP). They discovered large amounts of those proteins in urine samples from kidney cancer patients.

The AQP1 or ADFP proteins were not elevated in healthy individuals or surgery patients without cancer. The researchers also found that when the kidney tumors were removed, AQP1 and ADFP levels in the urine declined precipitously.

"We believe that in the same way we use mammograms to screen for breast cancer and blood tests to screen for prostate cancer, we may have the opportunity to detect these proteins in urine as a way to screen for kidney cancer," Kharasch says.

Kharasch, vice chancellor for research at Washington University, the Russell D. and Mary B. Shelden Professor of Anesthesiology and director of the Division of Clinical and Translational Research in the Department of Anesthesiology, has been working with lead author Morrissey, a research professor of anesthesiology, to detect kidney cancer at an earlier stage.

"When patients come to surgery, it tends to be late in the process, and many already have progressed to a stage where the prognosis is pretty bleak," says Morrissey. "Screening patients to find kidney cancer when it is still small and treatable could save a number of lives and preserve kidney function in many people. It also may represent the difference between losing an entire kidney or extracting only a tumor while sparing healthy portions of the organ."

About 50,000 patients are diagnosed with kidney cancer each year. And about 13,000 people die from the disease annually in the United States alone. A test that could lead to earlier diagnosis could make a big dent in those numbers, according to Timothy J. Eberlein, MD, director of the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

"One of the goals of the Siteman Cancer Center is to diagnose tumors as early as possible, when they are more curable," Eberlein says. "Most kidney tumors are found in more advanced stages, when the patient is symptomatic and less likely to be cured. These new findings open the door for a quick, noninvasive test and could revolutionize our approach to the early, accurate diagnosis of kidney cancer."

Morrissey says further testing will be required to determine whether people with other types of kidney disease also have high levels of AQP1 and ADFP in their urine, too. But based upon their findings, Kharasch and Morrisey have filed a patent application through Washington University's Office of Technology Management for use of aquaporin-1 and adipophilin to diagnose kidney cancer.

Because this study looked only at patients who already had a cancer diagnosis following an imaging test, Kharasch and Morrissey say more research will be needed to see how early in the disease process levels of the AQP1 or ADFP proteins rise and whether the concentration of those proteins in the urine might correspond to the size of a kidney tumor.

If the research continues to demonstrate that AQP1 and ADFP urine levels are good markers of kidney cancer, it may someday be possible for routine screening for the disease in a doctor's office, using a noninvasive urine test to determine whether or not they have the disease.

Morrissey JJ, London AN, Luo J, Kharasch ED. Urinary biomarkers for the early diagnosis of kidney cancer, Mayo Clinic Proceedings, vol. 85, number 5. May 2010. doi:10.4065/mcp.2009.0709

This research was supported by the Department of Anesthesiology at Washington University School of Medicine in St. Louis.

Source: Jim Dryden
Washington University School of Medicine