Urinary Biomarkers for Early Diabetic Nephropathy in Everyday Practice

Mini Review

J Dis Markers. 2014;1(2): 1008.

Urinary Biomarkers for Early Diabetic Nephropathy in Everyday Practice

Visnja Lezaic*

Medical School, Department of Nephrology, Clinical Centre of Serbia

*Corresponding author: Visnja Lezaic, Department of Nephrology, Clinical Centre of Serbia, Pasterova 2, 11000 , Belgrade, Serbia

Received: August 05, 2014; Accepted: Aug 22, 2014; Published: Aug 25, 2014


Diabetes Mellitus (DM) is a chronic disease that affects 6.4% of the adult population and is expected to rise to 552 million by 2030 [1]. This global increase in the prevalence of diabetes will inevitably lead to acceleration of micro- and macro vascular complications of diabetes. Diabetic Nephropathy (DN) is one the common micro vascular complication of diabetes mellitus- DM. It is a leading cause of end-stage renal disease in developed and developing countries and a contributor to significant morbidity and mortality in patients with diabetes [2]. Recent studies have demonstrated that the onset and course of DN can be ameliorated significantly by several interventions, but these interventions have their greatest impact if instituted at a very early stage in the course of the development of DN.

The last few years have provided a better insight into the complex pathophysiology of DN on a molecular level. Besides hemodynamic alterations such as hyper filtration and hyper perfusion, there is now clear evidence that these changes are only one aspect of a complex series of metabolic alterations caused by disturbed glucose homeostasis. All the kidney structure including glomerular endothelia, mesangial cells, podocytes, and tubular epithelia are affected in DN [3]. It is characterized by excessive accumulation of extracellular matrix with thickening of glomerular and tubular basement membranes and increased amount of mesangial matrix, which ultimately progresses to glomerulosclerosis and tubulointerstitial fibrosis [3,4]. Similar alterations occur in other organs, causing their damage, mainly cardiovascular, the leading cause of death in patients with DM. Even more, evidence support the hypothesis that early development of adverse vascular changes already existed prior to the development of overt diabetes i.e. in pre-diabetic conditions in both impaired fasting glucose and/or impaired glucose tolerance [5].

In order to detect early sign of DN all the available non-invasive techniques are in use. Some of them indirectly demonstrate the vascular and parenchymal renal damage by Doppler ultrasound such as quantification of arterial renal perfusion with Renal arterial Resistance Index (RRI) [6], detection of arterial stiffness by measurement of brachial-ankle pulse wave velocity (ba PWV), or carotid intimalmedia thickness [7] as early markers of atherosclerosis. The others based on the urinary appearance of an excess of serum proteins that are not normally freely filtered through the glomerular. Many of these proteins (called biomarkers) in serum and urine have been studied that represent different mechanisms or structural damage in DN, based on which they have been classified as markers of glomerular injury, tubular injury, oxidative stress, inflammation, and endothelial damage [8,9]. They are listed in Table 1.

Many of these biomarkers are not specific for DN. Therefore, this paper aimed to review the most common urinary markers of glomerular injury associated with DN that are actually in use in the early diagnosis of DN.

Citation:Lezaic V. Urinary Biomarkers for Early Diabetic Nephropathy in Everyday Practice. J Dis Markers. 2014;1(2): 1008. ISSN:2380-0682