Diabetic Nephropathy: Emerging Biomarkers for Risk Assessment

Progression of diabetic nephropathy (DN) is commonly defined by an increase in albuminuria from normoalbuminuria to microalbuminuria and from microalbuminuria to macroalbuminuria. Although early detection of DN can prevent or slow its progression, a major difficulty in inducing remission in patients with early DN is the identification of biomarkers that could help identify patients more likely to progress to end-stage renal disease (ESRD). Traditional risk factors such as albuminuria do not effectively predict DN progression, and other predictors of DN have yet to be characterized and validated. The need for discovering sensitive and easily detectable biomarkers to monitor the decline in renal function and to separate progressors from nonprogressors of DN is therefore of paramount importance.Recently, microRNAs (miRNAs) have emerged as one such potential class of biomarkers. Mature miRNAs are a class of evolutionarily conserved, short (20–22 nucleotides long), noncoding RNA that are potent regulators of gene expression. After several synthesis and processing steps, mature miRNAs are loaded into the RNA-induced silencing complex, which directs the miRNAs to its target messenger RNAs (mRNAs). Once bound to its target mRNA, the RNA-induced silencing complex can facilitate several forms of transcriptional repression depending on the strength of the miRNA-mRNA interaction and seed-sequence/target site complementarity, ultimately resulting in the loss of protein expression (1). Thus, the recent discovery of …