Diabetic nephropathy (DN) is a common complication of Diabetes Mellitus (DM) Types 1 and 2, and prevention of end stage renal disease (ESRD) remains a major challenge. Despite its high prevalence, the pathogenesis of DN is still controversial. Initial glomerular disease manifested by hyperfiltration and loss of glomerular size and charge permselectivity may initiate a cascade of injuries, including tubulo-interstitial disease. Clinically, ‘microalbuminuria’ is still accepted as an early biomarker of glomerular damage, despite mounting evidence that its predictive value for DN is questionable, and findings that suggest the proximal tubule is an important link in the development of DN. The concept of ‘diabetic tubulopathy’ has emerged from recent studies, and its causative role in DN is supported by clinical and experimental evidence, as well as plausible pathogenetic mechanisms. This review explores the ‘tubulocentric’ view of DN. The recent finding that inhibition of proximal tubule (PT) glucose transport (via SGLT2) is nephro-protective in diabetic patients is discussed in relation to the tubule’s potential role in DN. Studies with a tubulocentric view of DN have stimulated alternative clinical approaches to the early detection of diabetic kidney disease. There are tubular biomarkers considered as direct indicators of injury of the proximal tubule (PT), such as N-acetyl-β-D-glucosaminidase, Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1, and other functional PT biomarkers, such as Urine free Retinol-Binding Protein 4 and Cystatin C, which reflect impaired reabsorption of filtered proteins. The clinical application of these measurements to diabetic patients will be reviewed in the context of the need for better biomarkers for early DN.

Background and Aim The impact of hepatitis C virus (HCV) clearance by direct‐acting antiviral agents (DAAs) on HCV‐related extrahepatic manifestations is not well known. We evaluated the effect of viral clearance on metabolic and renal parameters. Methods In this prospective study, HCV patients who achieved a sustained virologic response (SVR) by DAAs were evaluated before, at the end, and 24 weeks after treatment for glycemic (serum glucose and insulin, HOMA‐IR, HOMA‐β, and HOMA‐S) and lipid (serum cholesterol, triglycerides, low‐density lipoprotein [LDL], high‐density lipoprotein) metabolism and renal function (serum creatinine, estimated glomerular filtration rate [eGFR]). Results A total of 343 consecutive HCV patients were evaluated. At 24 weeks of post‐follow‐up, an increase in body mass index (BMI) was observed ( P < 0.05). Regardless of hepatic fibrosis levels and BMI, a reduction in serum glucose ( P = 0.001), HOMA‐IR ( P < 0.001) and HOMA‐β ( P < 0.001) and an increase in HOMA‐S ( P < 0.001) values were observed at 24 weeks after HCV clearance as compared to pretreatment values; 32.4% of patients with impaired fasting glucose normalized serum glucose values and 44.6% of diabetics showed an improvement in glycemic control. In contrast, serum cholesterol ( P < 0.001) and LDL cholesterol ( P < 0.001) values were increased. Renal function was improved with about 10% reduction of serum creatinine values ( P < 0.02) and an increase of eGFR ( P < 0.001). A baseline eGFR of ≤60 mL/min/1.73 m 2 was a negative predictor of renal function improvement. HCV clearance was an independent factor improving glucose metabolism and renal function. Conclusions Our study shows an occurrence of changes in metabolic and renal parameters in HCV patients with SVR, anticipating possible future clinical scenarios that the clinician must know for proper management.

This work reports on the application of a distributed fiber-optic strain sensor for long-term monitoring of a railway tunnel affected by an active earthflow. The sensor has been applied to detect the strain distribution along an optical fiber attached along the two walls of the tunnel. The experimental results, relative to a two-year monitoring campaign, demonstrate that the sensor is able to detect localized strains, identify their location along the tunnel walls, and follow their temporal evolution.