D-アミノ酸における腎機能測定における有用性

抄録

Accurate assessment of glomerular filtration rate (GFR) is essential for the diagnosis and management of kidney disease, as well as for the evaluation of living kidney donors and kidney transplant recipients. However, conventional endogenous GFR markers have important limitations. Serum creatinine is influenced by muscle mass, age, sex, and nutritional status, whereas cystatin C may be affected by inflammation and corticosteroid treatment. Recent advances in chiral amino acid analysis have revealed that d-amino acids, particularly d-serine and d-asparagine, are closely associated with kidney function and may provide novel endogenous markers of GFR. These d-amino acids appear to be less dependent on age, sex, and body size than creatinine. Recent studies have further demonstrated that a GFR estimation equation combining d-serine and d-asparagine can achieve performance comparable to creatinine-based estimation without requiring age as an explanatory variable. These findings raise the possibility of a kidney function assessment applicable across a broad range of ages and clinical backgrounds. In this review, we summarize the physiological relationship between d-amino acids and the kidney, their potential as GFR biomarkers, and their possible clinical applications, particularly in kidney transplantation, while discussing the remaining challenges for their implementation in clinical practice.