Renal manifestations and diabetes mellitus: the missing link

Diabetes mellitus (DM), a persistent metabolic disorder marked by hyperglycemia, is linked to a heightened risk of kidney disease (KD). Diabetic kidney disease (DKD), a significant renal complication of DM, is a primary contributor to end-stage kidney disease (ESKD) and is linked to an elevated risk of cardiovascular incidents and mortality. The pathophysiology of DKD is multifactorial and is driven mainly by hyperglycemia. Despite efforts at maintaining good glycemic control and the widespread use of recommended therapies, individuals with DKD continue to develop ESKD. This has been attributed to the biological and analytical limitations associated with commonly used diagnostic biomarkers, coupled with possible variations in the pathophysiological mechanisms of DKD at play in specific individuals. Investigations have uncovered novel mechanistic pathways and biomarkers with the potential to develop personalized diagnostic approaches and therapeutic interventions. Employing a tailor-made strategy, perceived as a missing link in the care pathway for DKD, will facilitate timely diagnosis and therapy to reduce the burden of DKD.