Objective:

To evaluate the diagnostic performance and stage-wise behavior of urinary glomerular and tubular biomarkers for identifying diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM), emphasizing the significance of these stages in clinical practice.

Approach:

Key Findings:

• Both glomerular and tubular biomarkers were significantly elevated in DN, detectable even in eGFR stage G1.
• Urine albumin-to-creatinine ratio (UACR) had the highest single-marker discrimination for DN (AUC 0.93, 95% CI 0.90-0.96).
• Urinary β2-microglobulin performed best for stage discrimination (AUC 0.85, 95% CI 0.79-0.91).
• A combined model of UACR, urinary β2-microglobulin, and urinary N-acetyl-β-D-glucosaminidase improved discrimination (AUC 0.96, 95% CI not provided).

Interpretation:

Clinically available urinary biomarkers can distinguish DN from matched T2DM controls across eGFR stages, including preserved eGFR, and combining tubular injury markers with UACR enhances diagnostic performance, which is crucial for early intervention.

Limitations:

• The study is retrospective and conducted in a specific population, which may limit generalizability.
• Exclusion of patients with non-diabetic kidney diseases may affect the applicability of findings.
• Potential biases inherent in retrospective studies may influence results.

Conclusion:

Integrating tubular and glomerular biomarkers significantly enhances the diagnostic performance for identifying DN in T2DM patients.

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