• J Beige, J Drube, H von der Leyen, L Pape, and H Rupprecht.
• Abteilung Nephrologie und KfH Nierenzentrum, Klinik für Infektiologie, Nephrologie und Rheumatologie, Klinikum St. Georg, Delitzscher Str. 141, 04129, Leipzig, Deutschland. joachim.beige@sanktgeorg.de.
• Internist (Berl). 2020 Oct 1; 61 (10): 1094-1105.

BackgroundThe early detection and treatment of diabetic nephropathy (DN) is of crucial importance as patients with diabetes mellitus represent the largest proportion of patients on dialysis, with the highest morbidity and mortality. Currently, the first clinical sign of incipient DN is microalbuminuria, but its precision is not optimal. Many studies now report that proteins and peptides are new biomarkers in urine that primarily depict the pathophysiology of DN and thus allow for improved diagnosis of DN.ObjectivesThe presentation of new concepts for the early detection and treatment of DN for better patient management.Material And MethodsA systematic literature search was carried out.ResultsMany potential markers have been described in the search for new biomarkers to diagnose DN by urinary proteome analysis. However, many of these studies were not meaningful due to the small number of samples. This limitation led to inadequate validation of proteins that could not be confirmed as markers. However, the diagnostic benefit of CKD 273, a multimarker of 273 protein fragments, was sustainably demonstrated for the early diagnosis of DN. This multi-marker shows significant advantages in the precision of diagnosis and prognosis compared to albuminuria. Furthermore, many of its peptide markers map the molecular pathophysiology of DN.ConclusionsClinical urinary proteome analysis shows great benefits and is already an appropriate tool for the early detection of incipient DN.

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