Beige J, Drube J, von der Leyen H, Pape L, Rupprecht H
Abteilung Nephrologie und KfH Nierenzentrum, Klinik für Infektiologie, Nephrologie und Rheumatologie, Klinikum St. Georg, Delitzscher Str. 141, 04129, Leipzig, Deutschland.
Martin-Luther-Universität, Halle/Wittenberg, Deutschland.
Internist (Berl). 2020 Oct;61(10):1094-1105. doi: 10.1007/s00108-020-00863-4.
The early detection and treatment of diabetic nephropathy (DN) is of crucial importance as patients with diabetes mellitus represent the largest proportion of patients on dialysis, with the highest morbidity and mortality. Currently, the first clinical sign of incipient DN is microalbuminuria, but its precision is not optimal. Many studies now report that proteins and peptides are new biomarkers in urine that primarily depict the pathophysiology of DN and thus allow for improved diagnosis of DN.
The presentation of new concepts for the early detection and treatment of DN for better patient management.
A systematic literature search was carried out.
Many potential markers have been described in the search for new biomarkers to diagnose DN by urinary proteome analysis. However, many of these studies were not meaningful due to the small number of samples. This limitation led to inadequate validation of proteins that could not be confirmed as markers. However, the diagnostic benefit of CKD 273, a multimarker of 273 protein fragments, was sustainably demonstrated for the early diagnosis of DN. This multi-marker shows significant advantages in the precision of diagnosis and prognosis compared to albuminuria. Furthermore, many of its peptide markers map the molecular pathophysiology of DN.
Clinical urinary proteome analysis shows great benefits and is already an appropriate tool for the early detection of incipient DN.
糖尿病肾病（DN）的早期检测和治疗至关重要，因为糖尿病患者是接受透析治疗的患者中占比最大、发病率和死亡率最高的群体。目前，早期DN的首个临床体征是微量白蛋白尿，但其准确性并不理想。现在许多研究报告称，蛋白质和肽是尿液中的新型生物标志物，主要描绘了DN的病理生理学，从而有助于改善DN的诊断。
介绍DN早期检测和治疗的新概念，以更好地管理患者。
进行了系统的文献检索。
在通过尿蛋白质组分析寻找诊断DN的新生物标志物的过程中，已描述了许多潜在标志物。然而，由于样本数量少，这些研究中的许多并无意义。这一局限性导致无法将蛋白质确认为标志物，从而无法进行充分验证。然而，CKD 273（一种由273个蛋白质片段组成的多标志物）对DN早期诊断的诊断益处得到了持续证明。与白蛋白尿相比，这种多标志物在诊断准确性和预后方面显示出显著优势。此外，其许多肽类标志物描绘了DN的分子病理生理学。
临床尿蛋白质组分析显示出巨大益处，并且已经是早期检测早期DN的合适工具。
