Abstract
Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition—mainly cardiovascular ones—and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new “gold standard” biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN.
Highlights
Diabetic nephropathy (DN) represents an important cause of chronic kidney disease (CKD) that frequently leads to end stage renal disease (ESRD)
In Western countries, diabetes is a leading cause of chronic kidney disease frequently leading to chronic renal replacement therapy (RRT) due to ESRD [2]
Urinary biomarkers allow an assessment of early DN
Summary
Diabetic nephropathy (DN) represents an important cause of chronic kidney disease (CKD) that frequently leads to end stage renal disease (ESRD). The new tubular biomarkers have been detected in both type 1 and type 2 DM early renal dysfunction that precedes microalbuminuria. Journal of Diabetes Research involves numerous biomarkers They span the period of normoalbuminuria that precedes microalbuminuria and the evolution of renal involvement during microalbuminuria and macroalbuminuria. We insist on urinary biomarkers because they are drawn, which allows population screening, and because they can detect tubular lesions, which occur very early in DM. In a study on 216 patients, Araki et al found, after a 6-year follow-up, regression of microalbuminuria in 51% cases and progression to severely increased albuminuria in 28% cases [22]. As such we did not include this marker among glomerular biomarkers but approached it separately, according to its potential role as both a glomerular and tubular biomarker
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