Abstract. Diabetes now accounts for Ͼ40% of patients with ESRD. Despite significant progress in understanding diabetic nephropathy, the cellular mechanisms that lead to diabetesinduced renal damage are incompletely defined. For defining changes in protein expression that accompany diabetic nephropathy, the renal proteome of 120-d-old OVE26 transgenic mice with hypoinsulinemia, hyperglycemia, hyperlipidemia, and proteinuria were compared with those of background FVB nondiabetic mice (n ϭ 5). Proteins derived from whole-kidney lysate were separated by two-dimensional PAGE and identified by matrix-assisted laser desorption ionization-time-of-flight (MALDI-TOF) mass spectrometry. Forty-one proteins from 300 visualized protein spots were differentially expressed in diabetic kidneys. Among these altered proteins, expression of monocyte/neutrophil elastase inhibitor was increased, whereas elastase IIIB was decreased, leading to the hypothesis that elastin expression would be increased in diabetic kidneys. Renal immunohistochemistry for elastin of 325-d-old FVB and OVE26 mice demonstrated marked accumulation of elastin in the macula densa, collecting ducts, and pelvicalyceal epithelia of diabetic kidneys. Elastin immunohistochemistry of human renal biopsies from patients with type 1 diabetes (n ϭ 3) showed increased elastin expression in renal tubular cells and the interstitium but not glomeruli. These results suggest that coordinated changes in elastase inhibitor and elastase expression result in increased tubulointerstitial deposition of elastin in diabetic nephropathy. The identification of these coordinated changes in protein expression in diabetic nephropathy indicates the potential value of proteomic analysis in defining pathophysiology.Diabetes now accounts for Ͼ40% of patients with ESRD, and the number of renal failure patients with diabetes is expected to increase in the coming years (1). Renal pathologic changes that lead to decreased renal function are observed in all intrarenal structures, including glomeruli, tubulointerstitium, and blood vessels (2, 3). These morphologic changes, coupled with elevated intraglomerular pressure and hormonal dysregulation, lead to glomerulosclerosis, interstitial fibrosis, and ultimately renal failure (4, 5). Despite recent progress in understanding diabetic nephropathy, the cellular mechanisms that lead to diabetes-induced renal damage are incompletely defined.Recently, Clarkson et al. (6) demonstrated that at least 200 genes were differentially expressed in mesangial cells after exposure to high-glucose media. These findings indicate the complexity of the development of diabetic nephropathy. However, proteins, not genes, govern cellular functions. The study of changes in renal protein expression is necessary to understand better the complex pathogenic mechanisms of diabetic nephropathy. Conventional protein studies-Western blotting and other immunologic methods-are limited to a relatively small number of proteins that can be studied in each experiment and to previously ide...