Alamilla-Sanchez M, Yama Estrella MB, Morales López EF, Delgado Pineda D. Predictive value of biomarkers for tubulointerstitial and glomerular interactions in diabetic nephropathy. World J Nephrol 2025; 14(4): 103649 [DOI: 10.5527/wjn.v14.i4.103649]
Corresponding Author of This Article
Mario Alamilla-Sanchez, MD, Associate Professor, Department of Nephrology, November 20 National Medical Center, Félix Cuevas 540, Mexico City 03104, Colonia del Valle, Mexico. silenoz1@hotmail.com
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Urology & Nephrology
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 25, 2025 (publication date) through Dec 23, 2025
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World Journal of Nephrology
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2220-6124
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Alamilla-Sanchez M, Yama Estrella MB, Morales López EF, Delgado Pineda D. Predictive value of biomarkers for tubulointerstitial and glomerular interactions in diabetic nephropathy. World J Nephrol 2025; 14(4): 103649 [DOI: 10.5527/wjn.v14.i4.103649]
World J Nephrol. Dec 25, 2025; 14(4): 103649 Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.103649
Predictive value of biomarkers for tubulointerstitial and glomerular interactions in diabetic nephropathy
Mario Alamilla-Sanchez, Martin B Yama Estrella, Enrique F Morales López, Daniel Delgado Pineda
Mario Alamilla-Sanchez, Martin B Yama Estrella, Enrique F Morales López, Daniel Delgado Pineda, Department of Nephrology, November 20 National Medical Center, Mexico City 03104, Colonia del Valle, Mexico
Author contributions: Alamilla-Sanchez M designed the overall concept and outline of the manuscript; Alamilla-Sanchez M, Yama Estrella MB, Morales López EF, and Delgado Pineda D contributed to the discussion and design of the manuscript, the writing and editing of the manuscript, illustrations, and review of the literature; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mario Alamilla-Sanchez, MD, Associate Professor, Department of Nephrology, November 20 National Medical Center, Félix Cuevas 540, Mexico City 03104, Colonia del Valle, Mexico. silenoz1@hotmail.com
Received: November 26, 2024 Revised: March 23, 2025 Accepted: April 11, 2025 Published online: December 25, 2025 Processing time: 392 Days and 13.4 Hours
Abstract
This article comments on Varatharajan et al recent article, highlighting the role of tubulointerstitial damage mechanisms in diabetic nephropathy progression. Evidence suggests a bidirectional interaction between the interstitium, tubular cells, and glomeruli. Renal tubules are highly susceptible to proteinuria, metabolic disorders, and toxins. Since diabetic nephropathy persistently activates inflammatory and fibrotic pathways, epithelial-to-mesenchymal transition mechanisms present promising targets for risk assessment. Periostin, a cellular matrix protein, plays a key role in modulating extracellular interactions. Increased periostin expression in tissue, serum, and urine correlates with type 2 diabetes, making it a valuable biomarker alongside neutrophil gelatinase-associated lipocalin and kidney injury molecule-1. While periostin and neutrophil gelatinase-associated lipocalin reflect distal tubular damage, kidney injury molecule-1 serves as a marker for proximal tubular injury. Combining these biomarkers enhances diagnostic precision.
Core Tip: Diabetic kidney disease is characterized by albuminuria and progressive deterioration of renal function; however, traditional markers may fail to categorize a substantial proportion of patients who do not exhibit albuminuria. Tubulointerstitial biomarkers have been proven to be particularly valuable in predicting the onset of albuminuria and the progression of kidney injury in patients with type 2 diabetes. The standardization of biomarker measurements, including neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and periostin, can potentially enhance prognostic indicators for diabetic kidney disease.
