IDENTIFYING CLINICAL AND BIOCHEMICAL PREDICTORS OF PROGRESSION OF DIABETIC KIDNEY DISEASE

2000 WORDS  part 1

Diabetic kidney disease is one of the biggest risk factors for premature cardiovascular disease mortality and is also the main cause of end stage renal disease in the UK. Due to the large number of patients affected by the condition worldwide, it is imperative that new assays be developed for the early prediction of diabetic kidney disease. In current clinical practice, urinary albumin:creatinine ratio and estimated glomerular filtration rate (eGFR) are used as markers of the disease. However, the precision of these markers is questionable, as eGFR calculations lack reliability in hyperfiltration status and tissue involvement varies greatly between individuals, meaning renal impairment can occur without the presence of albuminuria, especially in type II diabetic patients. Therefore, there is a need for novel biomarkers that can assist in the early prediction of the disease to improve prognosis and disease outcomes. By reviewing literature on the pathophysiology of the disease, limitations of the current clinical biomarkers and the scope for novel predictors, we will discuss the strengths of novel biomarkers and metabolomic signatures to assess if they have a place in clinical practice.

INTRODUCTION

Approximately 1 in 4 adults with diabetes are affected by diabetic kidney disease [1,2]. In many regions, specifically developed countries, diabetic kidney disease is one of the most common complications of diabetes mellitus, as well as the main cause of chronic kidney disease.

Diabetic kidney disease is characterised, initially, by a fall in eGFR or albuminuria. The