Podocyte Stress Biomarker Shows Marginal Prognostic Value in Diabetic Kidney Disease

The study involved 118 patients with confirmed DKD through biopsy and 13 non-diabetic controls. Urinary mRNA levels of nephrin, podocin, and aquaporin-2 (AQP2) were quantified. Renal events, including death, dialysis, or a 40% reduction in glomerular filtration rate, were assessed at the 12-month mark.

Key Findings:

• The urinary podocin:nephrin mRNA ratio in DKD patients was significantly higher than in the control group (p = 0.0019).

• The ratio correlated with the severity of tubulointerstitial fibrosis in DKD patients (r = 0.254, p = 0.006).

• Higher urinary podocin:nephrin mRNA ratio was associated with reduced renal event-free survival at 12 months (unadjusted HR, 1.523; 95% CI 1.157–2.006; p = 0.003).

• After adjustments for clinical and pathological factors, the ratio exhibited a trend in predicting renal event-free survival (adjusted HR, 1.327; 95% CI 0.980–1.797; p = 0.067), though not reaching statistical significance.

The urinary podocin:nephrin mRNA ratio demonstrates marginal prognostic value in predicting renal events in biopsy-proven DKD. Further validation studies, especially in DKD patients without kidney biopsy, are crucial to establishing the biomarker's clinical significance.

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