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DIABETIC NEPHROPATHY »

Can biomarkers predict type 2 diabetic nephropathy?

The value of currently available urine biomarkers that identify those at risk for diabetic nephropathy is increasingly called into question. The development of new urine and plasma biomarkers to predict diabetic nephropathy may shed light on disease mechanisms. Also, rational clinical trial design will be made possible by such markers.

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Submitted by Jon Klein 3 years ago

Comments (6)

  1. Moderator

    Urine proteomics has yet to identify a robust biomarker for diagnosis/prognosis. Do you think couple tissue proteomics of kidney compartments [glomerulus v. tubulointerstitium] for biomarker discovery with targeted assay development in urine makes sense?

    3 years ago
  2. Here is an interesting article discussing biomarkers in general and biomarkers used in diabetic renal disease in detail:

    http://diabetes.diabetesjournals.org/content/57/6/1459.full

    What I got from reading this article is:

    1. albuminuria is virtually useless as an identifier

    a. Low-grade albuminuria (microalbuminuria)is a poor predictor of diabetic nephropathy

    b. High-grade albuminuria, which is a strong predictor of disease progression, only develops at advanced diabetic nephropathy, a stage when less can be done to prevent the development of end-stage kidney failure.

    2. Smad1 plays an important role in the development of mesangial expansion (using well-established mouse and rat models of diabetic nephropathy)

    3. Trying to determine whether urinary Smad1 levels measured at the time of diabetes development correlate with the development of mesangial expansion at later time points

    3 years ago
  3. Yes, this is an important area of research that will yield targeted therapies regarding who should be treated and who should not. While I disagree that albuminuria is virtually useless, there is a need for more specific biomarkers ideally those that have some pathogenic significance. For instance is the renin-angiotensin system overactive and when in the course of diabetic kidney disease.

    3 years ago
  4. Jon Klein Idea Submitter

    Sedor wrote: "Urine proteomics has yet to identify a robust biomarker for diagnosis/prognosis. Do you think couple tissue proteomics of kidney compartments [glomerulus v. tubulointerstitium] for biomarker discovery with targeted assay development in urine makes sense?"

    I think tissue proteomics coupled with targeted urine assays is absolutely a valid approach. In studies of SLE, Brad Rovin at OSU is using proteomic analysis of laser capture specimens to approach this problem.

    3 years ago
  5. Now if only the people doing proteomics understood the complexities of biomarker research and how to integrate clinical findings and parameters and disease progression with proteomics.

    3 years ago
  6. I think R Hurst is correct about about a disconnect between the -omics folks and biomarker development. Nevertheless, the ability to analyze large matrices would benefit the evaluation of renal disease.

    It seems too much biomarker effort goes into markers that correlate with currently known ones. This is the least beneficial strategy since an orthogonal marker is most likely to add to predictive value. The identification of unknown orthogonal markers is most likely to come from -omics work, however I would hate to see it restricted to proteomics. I'd expand it to include metabolomics... since that's what's being regulated...

    3 years ago

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