Early Urinary Markers for Diabetic and Other Kidney Diseases

Background: Nephropathy is a debilitating complication of diabetes associated with increased risk for renal failure, leading to poor quality of life of the affected patients and eventually to mortality. Early intervention is crucial to enhance the well-being of the patients with nephropathy. Albuminuria is a well-known predictor of weak renal outcomes in patients with diabetes and hypertension, unfortunately, it is not an early marker for kidney injury. Objective: Assessment of new and precise markers is necessary to predict the early onset and progression of nephropathy. It is important to find early markers which could predict kidney injury even before the clinical signs (no microalbuminuria) appear. Results: Prevention and therapy for kidney diseases using surrogate markers such as serum creatinine have not proven to be better indicators for interventions that have been shown to decrease morbidity or mortality. A number of studies have elucidated the importance of kidney injury markers. This article describes the significance of urinary markers such as nephrin, Cystatin C, Monocyte chemoattractant protein (MCP-1), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM- 1) and nestin, which are associated with early renal dysfunction. Conclusion: Although significant advances have been made in medical therapy, the degree of morbidity and mortality associated with kidney diseases remain despondently high. Besides the serum markers, urinary markers may provide a better prediction of progression of the damage to the kidneys in diabetic patients.