Biomarkers of progression in diabetic nephropathy: The past, present and future

Biomarkers of progression in diabetic nephropathy: The past, present and futureMore than 380 million people are currently suffering from diabetes.The International Diabetes Federation estimated that this would rise to 592 million within a generation.Despite this relentless increase in the prevalence of type 2 diabetes worldwide, with the advent of potent statins, there has been a gradual decline in mortality from macrovascular complications, such as stroke and coronary heart disease.However, this is not the situation in diabetic nephropathy, which remains a leading cause of end-stage renal disease (ESRD) globally, with its incidence being still on a rising trend.Notably, once nephropathy develops, approximately 20-40% of patients inevitably progress to ESRD.Therefore, we need biomarkers that would enable early risk stratification in diabetic nephropathy (Figure 1), so that those at higher risk of progression to ESRD are identified at early stages of nephropathy development.Long-term follow up of interventional studies, such as STENO-2, have clearly shown that, even at the stage of microalbuminuria, intensive multifactorial management targeting blood pressure (particularly with blockade of the renin-angiotensin system), glucose, cholesterol and lifestyle issues could reduce the progression to ESRD as well as the associated cardiovascular mortality.The availability of sensitive and well-validated biomarkers for nephropathy progression would allow targeted intensive management to be provided to those who would derive the most cost-effective benefits from such intervention.