Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Manipal, India.
Department of Gastroenterology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Manipal, India.
Int Urol Nephrol. 2023 Apr;55(4):913-928. doi: 10.1007/s11255-022-03354-7. Epub 2022 Oct 22.
The global burden of diabetic kidney disease (DKD) is escalating, and it remains as a predominant cause of the end-stage renal disease (ESRD). DKD is associated with increased cardiovascular disease and morbidity in all types of diabetes. Prediction of progression with albuminuria and eGFR is challenging in DKD, especially in non-proteinuric DKD patients. The pathogenesis of DKD is multifactorial characterized by injury to all components of the nephron, whereas albuminuria is an indicator of only glomerular injury. The limits in the diagnostic and prognostic value of urine albumin demonstrate the need for alternative and clinically significant early biomarkers, allowing more targeted and effective diabetic treatment, to reduce the burden of DKD and ESRD. Identification of biomarkers, based on multifactorial pathogenesis of DKD can be the crucial paradigm in the treatment algorithm of DKD patients. This review focuses on the potential biomarkers linked to DKD pathogenesis, particularly with the hope of broadening the diagnostic window to identify patients with different stages of DKD progression.
全球糖尿病肾病（DKD）负担不断增加，它仍然是终末期肾病（ESRD）的主要原因。DKD与所有类型糖尿病的心血管疾病发病率和发病率增加有关。在 DKD 中，用白蛋白尿和 eGFR 预测进展具有挑战性，尤其是在非蛋白尿性 DKD 患者中。DKD 的发病机制是多因素的，其特征是所有肾单位成分都受到损伤，而白蛋白尿只是肾小球损伤的一个指标。尿液白蛋白的诊断和预后价值有限，这表明需要替代的、具有临床意义的早期生物标志物，以实现更有针对性和更有效的糖尿病治疗，从而降低 DKD 和 ESRD 的负担。基于 DKD 的多因素发病机制来识别生物标志物，可能是 DKD 患者治疗算法中的关键范例。这篇综述重点介绍了与 DKD 发病机制相关的潜在生物标志物，特别是希望扩大诊断窗口，以识别处于不同 DKD 进展阶段的患者。
