Diagnostic challenges of diabetic kidney disease.

IF 3.8 3区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY
Biochemia Medica Pub Date : 2023-10-15 Epub Date: 2023-08-05 DOI:10.11613/BM.2023.030501
Marijana Vučić Lovrenčić, Sandra Božičević, Lea Smirčić Duvnjak
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引用次数: 0

Abstract

Diabetic kidney disease (DKD) is one of the most common microvascular complications of both type 1 and type 2 diabetes and the most common cause of the end-stage renal disease (ESRD). It has been evidenced that targeted interventions at an early stage of DKD can efficiently prevent or delay the progression of kidney failure and improve patient outcomes. Therefore, regular screening for DKD has become one of the fundamental principles of diabetes care. Long-established biomarkers such as serum-creatinine-based estimates of glomerular filtration rate and albuminuria are currently the cornerstone of diagnosis and risk stratification in routine clinical practice. However, their immanent biological limitations and analytical variations may influence the clinical interpretation of the results. Recently proposed new predictive equations without the variable of race, together with the evidence on better accuracy of combined serum creatinine and cystatin C equations, and both race- and sex-free cystatin C-based equation, have enabled an improvement in the detection of DKD, but also require the harmonization of the recommended laboratory tests, wider availability of cystatin C testing and specific approach in various populations. Considering the complex pathophysiology of DKD, particularly in type 2 diabetes, a panel of biomarkers is needed to classify patients in terms of the rate of disease progression and/or response to specific interventions. With a personalized approach to diagnosis and treatment, in the future, it will be possible to respond to DKD better and enable improved outcomes for numerous patients worldwide.

糖尿病肾病的诊断挑战。
糖尿病肾病(DKD)是1型和2型糖尿病最常见的微血管并发症之一,也是终末期肾病(ESRD)最常见的原因。有证据表明,在DKD早期进行有针对性的干预可以有效预防或延缓肾衰竭的进展,并改善患者的预后。因此,定期筛查DKD已成为糖尿病护理的基本原则之一。长期建立的生物标志物,如基于血清肌酐的肾小球滤过率和蛋白尿估计,目前是常规临床实践中诊断和风险分层的基石。然而,它们内在的生物学局限性和分析变异可能会影响对结果的临床解释。最近提出的不含种族变量的新预测方程,加上血清肌酐和胱抑素C联合方程以及基于种族和性别的胱抑素C方程具有更好准确性的证据,使DKD的检测得以改善,但也需要协调推荐的实验室测试,胱抑素C检测的更广泛可用性和在不同人群中的特异性方法。考虑到DKD的复杂病理生理学,特别是在2型糖尿病中,需要一组生物标志物来根据疾病进展率和/或对特定干预措施的反应对患者进行分类。通过个性化的诊断和治疗方法,未来将有可能更好地应对DKD,并改善全球众多患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Biochemia Medica
Biochemia Medica 医学-医学实验技术
CiteScore
5.50
自引率
3.00%
发文量
70
审稿时长
>12 weeks
期刊介绍: Biochemia Medica is the official peer-reviewed journal of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Journal provides a wide coverage of research in all aspects of clinical chemistry and laboratory medicine. Following categories fit into the scope of the Journal: general clinical chemistry, haematology and haemostasis, molecular diagnostics and endocrinology. Development, validation and verification of analytical techniques and methods applicable to clinical chemistry and laboratory medicine are welcome as well as studies dealing with laboratory organization, automation and quality control. Journal publishes on a regular basis educative preanalytical case reports (Preanalytical mysteries), articles dealing with applied biostatistics (Lessons in biostatistics) and research integrity (Research integrity corner).
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