Skimming the fat in diabetic kidney disease: KIM-1 and tubular fatty acid uptake

Diabetic kidney disease (DKD) accounts for >40% of incident ESKD cases. The clinical hallmarks of DKD include reduced glomerular filtration rate (GFR) and increased urinary albumin excretion. Although DKD is traditionally considered a glomerular disease, tubulointerstitial injury is recognized as an important predictor of chronic kidney disease progression in diabetes. Tubular atrophy and interstitial fibrosis are strongly correlated with the progression of diabetic nephropathy to ESKD. Further supporting the role of tubules in DKD progression, the sodium/glucose cotransporter 2 (SGLT2) expressed in proximal tubules has emerged as a major therapeutic target for DKD.