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Biomarkers for evaluating renal function decline in diabetes: where are we now?

Janet K Snell-Bergeon

Diabetes causes increased mortality and healthcare costs, and prevalence is increasing worldwide. Diabetic nephropathy is the leading cause of end-stage renal disease, and is closely tied to cardiovascular disease, the main cause of death in people with diabetes. Renal function decline as measured by estimated glomerular filtration rate has emerged as a more reliable marker of kidney damage than urinary albumin, and markers for renal function decline are discussed in this review. Renal damage appears to be related to a series of effects of the hyperglycemia and insulin resistance that accompanies both Type 1 and Type 2 diabetes, including insulin resistance, accumulation of advanced glycation end products, uric acid and oxidative stress, often mediated by genetic susceptibility.