The world’s population is aging, with the number of older adults projected to increase dramatically over the next two decades. This trend poses major challenges to health care systems, reflecting the greater healthcare utilization by and more comorbid conditions among elderly adults. Chronic kidney disease (CKD) is a substantial concern in the elderly, with both an increasing incidence of treated kidney failure with dialysis as well as a high prevalence of earlier stages of CKD. Given the high burden of risk factors for CKD, the high prevalence of CKD in the elderly is not surprising, with the rise in obesity, diabetes and hypertension in middle-aged adults likely foreshadowing further increases in CKD prevalence among the elderly. It is now commonly agreed that the presence of CKD identifies a higher risk state in the elderly, with increased risk for multiple adverse outcomes, including kidney failure, cardiovascular disease, cognitive impairment, and death. Accordingly, CKD in older adults is worthy of attention by both health care providers and patients, with the presence of a reduced GFR or albuminuria in the elderly potentially informing therapeutic and diagnostic decisions for these individuals.

Diabetic nephropathy, the leading cause of renal failure worldwide, affects approximately one-third of all people with diabetes. Microalbuminuria is considered the first sign and the best predictor of progression to renal failure and cardiovascular events. However, albuminuria has several limitations. Therefore, earlier, more sensitive and specific biomarkers with greater predictability are needed. The aim of this paper is to discuss the current literature on biomarkers of glomerular injury that have been implicated in diabetic kidney disease.

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