Assessing renal structural alterations and outcomes

Abstract

This document provides methods and materials involved in assessing renal structural alterations (e.g., renal fibrosis, glomerular basement thickening, mesangial matrix expansion, swollen podocytes, and foot processes effacement) as well as methods and materials involved in assessing outcomes. For example, methods and materials for using the level of urinary CNP (e.g., a urinary to plasma CNP ratio) to determine whether or not a mammal is developing renal structural alterations (e.g., renal fibrosis, glomerular basement thickening, mesangial matrix expansion, swollen podocytes, and foot processes effacement) as well as methods and materials for using the level of urinary CNP levels to identify patients having an increased likelihood of experiencing a poor outcome are provided.

1 - 60 . (canceled) 
     
     
         61 . A method for treating a mammal having an increased risk of a renal structural alteration, wherein said method comprises:
 (a) determining that said mammal has an elevated urinary CNP to plasma CNP ratio,   (b) monitoring said mammal for the presence of a risk factor for renal structural alteration, and   (c) instructing said mammal to administer a therapeutic agent to reduce a symptom of said renal structural alteration.   
     
     
         62 . The method of  claim 61 , wherein said mammal is a human. 
     
     
         63 . The method of  claim 61 , wherein said elevated urinary CNP to plasma CNP ratio is greater than 12,000 pg/day to 16 pg/mL. 
     
     
         64 . The method of  claim 61 , wherein said elevated urinary CNP to plasma CNP ratio is greater than 13,200 pg/day to 18 pg/mL. 
     
     
         65 . The method of  claim 61 , wherein said risk factor is selected from the group consisting of an age factor, hypertension, an elevated serum creatinine level, proteinuria, an elevated body mass index, an elevated cholesterol level, a smoking habit, and diabetes. 
     
     
         66 . The method of  claim 61 , wherein said therapeutic agent is an ACE inhibitor, an angiotensin receptor blocker, an aldosterone antagonist, a statin, a native natriuretic peptide, or a designer natriuretic peptide. 
     
     
         67 . A method for treating a mammal having an increased risk of a poor outcome, wherein said method comprises:
 (a) determining that said mammal has an elevated level of urinary CNP,   (b) monitoring said mammal for the presence of a risk factor for a poor outcome, and   (c) instructing said mammal to administer a therapeutic agent to reduce the likelihood of said poor outcome.   
     
     
         68 . The method of  claim 67 , wherein said mammal is a human. 
     
     
         69 . The method of  claim 67 , wherein said urinary CNP is urinary NT-CNP-53. 
     
     
         70 . The method of  claim 67 , wherein said elevated level is greater than 36,000 pg of NT-CNP-53/day. 
     
     
         71 . The method of  claim 67 , wherein said elevated level is greater than 42,000 pg of NT-CNP-53/day. 
     
     
         72 . The method of  claim 67 , wherein said risk factor is selected from the group consisting of an age factor, hypertension, an elevated serum creatinine level, proteinuria, an elevated body mass index, an elevated cholesterol level, a smoking habit, and diabetes. 
     
     
         73 . The method of  claim 67 , wherein said therapeutic agent is an ACE inhibitor, an angiotensin receptor blocker, an aldosterone antagonist, a statin, a native natriuretic peptide, or a designer natriuretic peptide. 
     
     
         74 . A method for treating a mammal having an increased risk of myocardial infarction, wherein said method comprises:
 (a) determining that said mammal has an elevated level of plasma CNP-22,   (b) monitoring said mammal for the presence of a risk factor for myocardial infarction, and   (c) instructing said mammal to administer a therapeutic agent to reduce the risk of myocardial infarction.   
     
     
         75 . The method of  claim 74 , wherein said mammal is a human. 
     
     
         76 . The method of  claim 74 , wherein said elevated level is greater than 14 pg/mL. 
     
     
         77 . The method of  claim 74 , wherein said elevated level is greater than 16 pg/mL. 
     
     
         78 . The method of  claim 74 , wherein said risk factor is selected from the group consisting of an age factor, hypertension, an elevated serum creatinine level, proteinuria, an elevated body mass index, an elevated cholesterol level, a smoking habit, and diabetes. 
     
     
         79 . The method of  claim 74 , wherein said therapeutic agent is an ACE inhibitor, an angiotensin receptor blocker, an aldosterone antagonist, a statin, a native natriuretic peptide, or a designer natriuretic peptide.