Diagnostic challenges of diabetic kidney disease

Abstract

Diabetic kidney disease (DKD) is one of the most common microvascular complications of both type 1 and type 2 diabetes and the most common cause of the end-stage renal disease (ESRD). It has been evidenced that targeted interventions at an early stage of DKD can efficiently prevent or delay the progression of kidney failure and improve patient outcomes. Therefore, regular screening for DKD has become one of the fundamental principles of diabetes care. Long-established biomarkers such as serum-creatinine-based estimates of glomerular filtration rate and albuminuria are currently the cornerstone of diagnosis and risk stratification in routine clinical practice. However, their immanent biological limitations and analytical variations may influence the clinical interpretation of the results. Recently proposed new predictive equations without the variable of race, together with the evidence on better accuracy of combined serum creatinine and cystatin C equations, and both race- and sex-free cystatin C-based equation, have enabled an improvement in the detection of DKD, but also require the harmonization of the recommended laboratory tests, wider availability of cystatin C testing and specific approach in various populations. Considering the complex pathophysiology of DKD, particularly in type 2 diabetes, a panel of biomarkers is needed to classify patients in terms of the rate of disease progression and/or response to specific interventions. With a personalized approach to diagnosis and treatment, in the future, it will be possible to respond to DKD better and enable improved outcomes for numerous patients worldwide.

The role of long non‐coding RNAs in the development of diabetic kidney disease and the involved clinical application

“…Nevertheless, eGFR and urine protein may be within the normal range because the clinical symptoms of DKD are atypical in the early stage, and these conventional diagnostic methods are unable to meet clinical needs. 128 Therefore, to enhance DKD diagnosis and assessment, new sensitive and noninvasive biomarkers are required. Following the advancement of detection technology, lncRNAs have been not only thoroughly studied but also identified as new diagnostic biomarkers for DKD.…”

“…Among them, renal puncture biopsy is the gold standard for the diagnosis of DKD, but it is expensive and invasive, which is not easy to popularise in clinical practice. Nevertheless, eGFR and urine protein may be within the normal range because the clinical symptoms of DKD are atypical in the early stage, and these conventional diagnostic methods are unable to meet clinical needs 128 . Therefore, to enhance DKD diagnosis and assessment, new sensitive and non‐invasive biomarkers are required.…”