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Diabetic kidney disease is the leading cause of renal failure in the U.S. and Western industrialized countries, affecting 20–30% of type 1 and type 2 diabetic patients. With the expansion of the obesity and type 2 diabetes epidemic worldwide and particularly in Asia, we can only anticipate an increase in the worldwide incidence of diabetic renal disease (1). It is difficult to overstate the physical, social, economic, and personal burdens created by diabetic nephropathy. And yet, caregivers are in many ways adrift in their efforts to predict which diabetic patients will develop progressive renal dysfunction. Those who wish to develop new pharmaceuticals to prevent or reverse diabetic nephropathy are also at a loss to accurately identify the subpopulation of patients with diabetes that will develop nephropathy and potentially benefit from new treatments. The judgment of clinicians as to who will develop diabetic nephropathy has come unmoored as a result of the loss of microalbuminuria as a biomarker of progressive renal dysfunction in patients with diabetes. In type 1 diabetic patients, confidence in the predictive value of microalbuminuria has declined as a result of observations that a large proportion of patients with microalbuminuria revert to normoalbuminuria and, in a significant percentage of patients, renal function has declined before the onset of microalbuminuria (2,3). In …

Biomarkers That Predict Diabetic Nephropathy: The Long Road From Finding Targets to Clinical Use