Biomarkers in diabetic kidney disease

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Date: Mar. 2011
From: Therapy(Vol. 8, Issue 2)
Publisher: Future Medicine Ltd.
Document Type: Report
Length: 4,820 words
Lexile Measure: 1420L

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Author(s): Jaya P Buddineni 1 , Kunal Chaudhary 2 3 , Adam Whaley-Connell [[dagger]â ] 4

KEYWORDS

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ADMA; asymmetrical dimethylarginine; kidney injury molecule-1; KIM-1; MMP-9; neutrophil gelatinase-associated lipocalcin; NGAL; TGF-[beta]β

Diabetes has become a global public health dilemma and will continue to pose a major challenge throughout the 21st century for healthcare providers. The prevalence of diabetes (both diagnosed and undiagnosed) is approximately 14% of the adult population in the USA according to a 2007 census, and this number is estimated to increase to 21-â33% by the year 2050 [101] . All-cause mortality attributable to diabetes in the adult population in North America and the Caribbean region is higher than the general population for cardiovascular disease and cancer [1] . Past studies have shown that the onset and progression of Type 2 diabetes mellitus (T2DM) in high-risk individuals could be prevented and/or postponed with lifestyle modification and medications [2,3] . Recognizing individuals with a high risk of developing diabetes has therefore become an essential process for targeting preventive measures. Even though numerous risk equation scores based on genetic factors [4] , clinical indicators [5] and lifestyle modifiers [6] have been published, none of them have been established as a universal practical tool for prediction of complications related to diabetes. Thus, the emergence of biomarkers has gained significant interest both to improve clinical predictions of diabetes and also to understand the pathogenesis of the disease.

The most commonly used measures for detection of kidney function in the diabetic population by healthcare providers, such as serum creatinine, calculation of glomerular filtration rate (GFR) and proteinuria, largely identify an underlying pathologic process that is well established [7] . Eventually, this has led to an increased effort to identify new biomarkers that reflect kidney function and injury that can ultimately predict the progression or regression of kidney damage early in the disease process. Newer technologies, such as genomic analysis involving RNA subtraction, DNA microarrays and proteomic approaches, to identify novel proteins that reflect renal injury are rapidly emerging. Urine itself is being used as a diagnostic medium for noninvasive detection of biomarkers. Although these biomarkers are not used in clinical settings at present, there is potential for clinical utility of new biomarkers in diabetic kidney disease. They may assist in the early detection of kidney disease in the preproteinuric phase as well as monitor the progression of kidney disease and help in differentiating diabetic kidney disease from other causes of proteinuria, thus enabling diagnosis and management of the disease process.

Albuminuria & renal injury

Albumin is the most abundant water soluble protein in plasma, originating from the liver. Under normal physiological conditions, most of the urinary albumin filtered through the glomerulus is later reabsorbed by proximal tubular cells. In diabetics, alterations in glomerular filtration or proximal tubule reabsorption contribute to increased excretion of urinary albumin. Albuminuria (proteinuria) in diabetic patients is an independent risk factor for development of both renal and cardiovascular complications in diabetic and general populations [8,9] . Importantly, some investigators believe albumin per se may play a direct role in the progression of...

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Gale Document Number: GALE|A252312105