kidney<\/a> disease (DKD).<\/p>\nLooking beyond albuminuria<\/p>\n
Diabetic kidney disease is a common complication of diabetes and can lead to a progressive decline in kidney function.<\/p>\n
Albuminuria \u2013 an increased amount of the protein albumin in the urine \u2013 is widely used to assess kidney damage and monitor the progression of DKD.<\/p>\n
However, not everyone with DKD follows the same pattern. Some people experience declining kidney function without a corresponding increase in albuminuria, highlighting the need for additional ways to assess kidney health.<\/p>\n
Researchers in South Korea therefore investigated non-albumin proteinuria, which includes proteins associated with damage to the kidney tubules.<\/p>\n
They wanted to determine whether levels changed following treatment with finerenone and whether NAP could potentially be used as a marker of treatment response.<\/p>\n
What did the study find?<\/p>\n
The researchers analysed data from 477 adults with Type 2 diabetes who had been treated with finerenone, a non-steroidal mineralocorticoid receptor antagonist used to lower the risk of kidney failure, heart attacks, and death from heart disease in people with chronic kidney disease linked to the disease.<\/p>\n
After six months of treatment, albuminuria had fallen by 30.3%, while non-albumin proteinuria had fallen by 17.5%. However, the reduction in NAP differed depending on how much protein participants had in their urine before starting treatment.<\/p>\n
Among people with higher baseline proteinuria, NAP fell by 18.8%. In those with lower baseline proteinuria, researchers recorded a 1.3% change, which was not statistically significant.<\/p>\n
Changes in NAP were also associated with changes in another urinary marker called N-acetyl-\u03b2-D-glucosaminidase (NAG), which is used as a marker of injury to the kidney tubules.<\/p>\n
Together, the results raise the possibility that monitoring non-albumin proteins could provide information about kidney changes that are not captured by albuminuria alone.<\/p>\n
Could it lead to more personalised treatment?<\/p>\n
Finerenone is already used to reduce the risk of kidney and cardiovascular complications in certain people with chronic kidney disease associated with type 2 diabetes.<\/p>\n
The researchers suggest that measuring NAP alongside albuminuria could potentially help identify different patterns of kidney disease and provide additional information about how someone is responding to treatment.<\/p>\n
Importantly, however, the findings do not yet show that NAP should be routinely used to guide treatment decisions.<\/p>\n
The research was a retrospective observational study conducted at a single hospital. This means it can show an association between finerenone treatment and changes in NAP, but cannot establish that the medication directly caused those changes.<\/p>\n
The researchers said prospective studies involving multiple centres are now needed to determine whether NAP can reliably predict treatment response and, importantly, whether changes in NAP correspond with better long-term kidney outcomes.<\/p>\n
The findings nevertheless suggest that looking beyond albumin alone could offer another way to understand the varied effects of diabetic kidney disease and, in the future, potentially support a more personalised approach to its management.<\/p>\n
Reference<\/p>\n
Choi M S et al. Non-albumin proteinuria as a candidate biomarker of treatment response to finerenone in diabetic kidney disease: a real-world cohort study. Front. Endocrinol. 2026. 17:1918192.<\/p>\n
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