{"title":"Urinary L-FABP: A Novel Biomarker for Evaluating Diabetic Nephropathy Onset and Progression. A Narrative Review.","authors":"Ersilia Satta, Felice Strollo, Luisa Borgia, Giuseppina Guarino, Carmine Romano, Mario Masarone, Raffaele Marfella, Sandro Gentile","doi":"10.1007/s13300-025-01731-w","DOIUrl":null,"url":null,"abstract":"<p><p>Patients with diabetes mellitus (DM) are at risk of developing diabetic nephropathy (DN), a condition whose onset and progression are linked to increased morbidity and mortality. Therefore, early recognition is crucial. Presently, this relies on the albumin excretion rate (AER) and glomerular filtration rate (GFR). Nevertheless, DN eventually affects patients with normal AER and GFR. Thus, further easy-to-handle biomarkers of DN onset/worsening are needed. Liver-type fatty acid-binding protein (L-FABP) has been associated with renal damage and could help predict/diagnose DN. We performed a literature selection to evaluate the performance of urinary excretion of such biomarker (urinary-L-FABP:uL-FABP) in predicting/diagnosing DN and its progression in diabetes. We evaluated 635 publications, 21 of which were included. Of these, 14 have cross-sectional design/arms and ten longitudinal design/arms. Cross-sectional studies showed uL-FABP to correlate with DN onset and severity in type-1 DM and type-2 DM, besides being higher than in healthy controls in the case of normoalbuminuria. Longitudinal studies showed baseline uL-FABP to predict DN onset in normoalbuminuric patients with T1DM and DN progression independently of diabetes type. The results suggest that uL-FABP is a marker of tubular damage detectable before increased albumin excretion and can represent the earliest sign of DN. Indeed, it discloses its onset and often predicts its severity in T2DM and patients with T1DM. Currently, uL-FABP can be routinely assessed and, being available as a point-of-care fast-test kit, may also become an easy-to-handle diagnostic tool for outpatients. In conclusion, uL-FABP represents a user-friendly biomarker of DN and can even predict DN progression in T2DM and T1DM over time.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1107-1124"},"PeriodicalIF":2.6000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085547/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13300-025-01731-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/3 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Patients with diabetes mellitus (DM) are at risk of developing diabetic nephropathy (DN), a condition whose onset and progression are linked to increased morbidity and mortality. Therefore, early recognition is crucial. Presently, this relies on the albumin excretion rate (AER) and glomerular filtration rate (GFR). Nevertheless, DN eventually affects patients with normal AER and GFR. Thus, further easy-to-handle biomarkers of DN onset/worsening are needed. Liver-type fatty acid-binding protein (L-FABP) has been associated with renal damage and could help predict/diagnose DN. We performed a literature selection to evaluate the performance of urinary excretion of such biomarker (urinary-L-FABP:uL-FABP) in predicting/diagnosing DN and its progression in diabetes. We evaluated 635 publications, 21 of which were included. Of these, 14 have cross-sectional design/arms and ten longitudinal design/arms. Cross-sectional studies showed uL-FABP to correlate with DN onset and severity in type-1 DM and type-2 DM, besides being higher than in healthy controls in the case of normoalbuminuria. Longitudinal studies showed baseline uL-FABP to predict DN onset in normoalbuminuric patients with T1DM and DN progression independently of diabetes type. The results suggest that uL-FABP is a marker of tubular damage detectable before increased albumin excretion and can represent the earliest sign of DN. Indeed, it discloses its onset and often predicts its severity in T2DM and patients with T1DM. Currently, uL-FABP can be routinely assessed and, being available as a point-of-care fast-test kit, may also become an easy-to-handle diagnostic tool for outpatients. In conclusion, uL-FABP represents a user-friendly biomarker of DN and can even predict DN progression in T2DM and T1DM over time.
糖尿病(DM)患者有发生糖尿病肾病(DN)的风险,这种疾病的发病和进展与发病率和死亡率增加有关。因此,早期识别是至关重要的。目前,这主要取决于白蛋白排泄率(AER)和肾小球滤过率(GFR)。然而,DN最终会影响AER和GFR正常的患者。因此,需要进一步易于处理的DN发病/恶化的生物标志物。肝型脂肪酸结合蛋白(L-FABP)与肾损害有关,可以帮助预测/诊断DN。我们进行了文献筛选,以评估尿排泄中这种生物标志物(尿- l - fabp:uL-FABP)在预测/诊断DN及其糖尿病进展中的作用。我们评估了635篇文献,其中21篇被纳入。其中14个是横截面设计/臂,10个是纵向设计/臂。横断面研究显示,uL-FABP与1型糖尿病和2型糖尿病的DN发病和严重程度相关,除了在正常蛋白尿的情况下高于健康对照组。纵向研究显示基线uL-FABP可预测尿白蛋白正常的T1DM患者的DN发病,且与糖尿病类型无关。结果表明,uL-FABP是在白蛋白排泄增加之前检测到的肾小管损伤的标志物,可以代表DN的最早征兆。事实上,它揭示了T2DM和T1DM患者的发病情况,并经常预测其严重程度。目前,uL-FABP可以进行常规评估,作为一种即时快速检测试剂盒,也可能成为门诊患者易于操作的诊断工具。总之,uL-FABP是一种用户友好的DN生物标志物,甚至可以随着时间的推移预测T2DM和T1DM的DN进展。
期刊介绍:
Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.