Omen in the blood

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Science  20 Apr 2018:
Vol. 360, Issue 6386, pp. 254-258
DOI: 10.1126/science.360.6386.254

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In an elegant but still unfolding story of molecular detective work, researchers hunting for a cause of chronic kidney disease have homed in on a protein known as soluble urokinase plasminogen activator receptor (suPAR). Historically, the leading risk factors for the disease have been high blood pressure, diabetes, and certain mutations that are more common in African-Americans. But recent findings have convinced some researchers that suPAR can directly attack the kidney, and that high levels increase risk far more than any other factor. Others aren't convinced. But people on both sides are fascinated by suPAR, a molecular marker that, at elevated levels in the blood, seems to presage many health calamities, such as heart attacks, diabetes, and premature death. The molecule appears to be a potent signal broadcast by an immune system under siege. It is exquisitely sensitive to inflammation, an accelerant for many diseases.