Newly found biomarkers may help predict diabetic nephropathy risk

Scientists have identified three plasma biomarkers of diabetic nephropathy, a frequent complication of type 2 diabetes, according to a study (Plasma Biomarkers and Kidney Function Decline in Early and Established Diabetic Kidney Disease) published in the Journal of the American Society of Nephrology. The three potential biomarkers, TNF receptor-1 (TNFR-1), TNFR-2, and kidney injury molecule-1 (KIM-1), may not only predict diabetic nephropathy risk but also evaluate treatment effectiveness.

The work is conducted by Steven Coca, Girish Nadkarni, and Bart Ferket‖from Icahn School of Medicine at Mount Sinai, Yuan Huang, Jane Zhang, SusanCrowley from Veterans Affairs Connecticut Healthcare System, Linda Fried from the University of Pittsburgh, Dennis Moledina, Veena Rao, and Chirag Parikh from Yale University School of Medicine.

Diabetes can cause a wide range of complications, including short-term complications such as hypoglycaemia diabetic ketoacidosis, and hyperosmolar hyperglycaemic state and long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease. These complications affect a large percentage of patients with diabetes and are responsible for considerable morbidity. Although it is known that diabetes causes various changes to metabolism and blood circulation, the precise mechanism of how diabetes trigger these complications is still unclear.

Diabetic nephropathy, or diabetic kidney disease, occurs when kidney filtration function is damaged. It is characterized by nephrotic syndrome and diffuse scarring of the glomeruli. Early diabetic kidney disease often has no symptoms while the advanced disease may trigger severe tiredness, headaches, nausea, vomiting, leg swelling. Diabetic kidney disease is the leading cause of kidney failure worldwide, and a lot of patients need dialysis or a kidney transplant.

Pathophysiologic mechanisms of diabetic kidney disease are incompletely understood. In addition, there is a lack of biomarkers that can be used to predict individual disease risk. Now a group of researchers, headed by Prof. Chirag Parikh at Yale University School of Medicine, has identified three proteins that may act as biomarkers of both early and established diabetic kidney disease.

In the study, Parikh's team used plasma samples from patients with early and advanced diabetic kidney disease. The levels of three specific proteins, TNFR-1, TNFR-2, and KIM-1, were measured. By comparing the levels of these proteins and decline in kidney filtration function, the researchers found that TNFR-1, TNFR-2, and KIM-1 independently associated with higher risk of kidney function decline in the patients.

In conclusion, the study demonstrates that the three proteins TNFR-1, TNFR-2, and KIM-1 may be useful in predicting kidney disease progression in individuals with diabetes. Additionally, measurement of these biomarkers could be an approach to evaluate treatment effectiveness. The findings, if confirmed, could enable early disease intervention and therefore prevent early diabetic kidney disease from progressing to more severe form, and this would save a lot of patients’ lives.

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