Early Detection of a Kidney Disease – Where do we Stand Today?

Abstract

Chronic kidney disease (CKD) represents a major global health burden, with early detection of glomerular injury remaining a persistent clinical challenge. The urinary albumin-to-creatinine ratio (UACR), although widely accepted as a diagnostic and prognostic marker, primarily reflects established structural damage. Urinary nephrin, a podocyte-specific transmembrane protein integral to the slit diaphragm, has emerged as a sensitive and mechanistically precise indicator of early podocyte injury. Detection of nephrinuria precedes the onset of albuminuria and correlates with disease activity across diabetic nephropathy, preeclampsia, and immune-mediated glomerulopathies. Comparative evaluation suggests that nephrinuria provides superior temporal and pathophysiological insight into glomerular injury. Incorporation of urinary nephrin into clinical practice, alongside UACR, holds potential to refine early CKD diagnostics and to facilitate a transition toward precision-based renal risk assessment and timely therapeutic intervention.