Con: Biomarkers in glomerular diseases: putting the cart before the wheel?

Biomarkers have been increasingly sought to improve diagnosis as well as predict prognosis and/or response to therapy. However, they should not replace sound clinical judgment and therapeutic measures. The present article aims to highlight the issues with biomarker research in three selected entities. In focal segmental glomerulosclerosis, many studies fail to differentiate cases of primary versus secondary forms leading to conclusions that are uninterpretable. Biomarkers have also been sought to predict development of diabetic nephropathy but this research should not supersede efforts aimed to optimize treatment of diabetes. Finally, in lupus nephritis (LN), biomarkers so far have failed to prove value in clinical practice. The concept of immunological remission should be added to the concept of clinical remission when judging response to immunosuppressive therapy in LN. In addition, the appropriate time frame for remission to occur should be reconsidered.