Evidence of chronic kidney injury in patients not meeting KDIGO criteria for chronic kidney disease

Subjects not meeting KDIGO criteria for chronic kidney disease (CKD), i.e. normoalbuminuric (urinary albumin:creatinine ratio, UACR <30 mg/g) individuals with an estimated glomerular filtration rate >60 mL/min/1.73 m(2), are considered at no increased cardiovascular or kidney risk associated with kidney disease, but the incidence of subclinical atherosclerosis, cardiovascular events and CKD progression is already increased in the high-normal UACR range (10–30 mg/g). Earlier intervention in this subclinical pre-CKD stage may diminish cardiorenal risk. However, tools to predict albuminuria development and to identify those subjects who will benefit most from intervention are limited. Recent data have identified urine molecular changes within the normoalbuminuria condition, consisting of an altered urinary peptidome, proteome and metabolome, which represent subclinical organ damage and processes such as inflammation, oxidative stress, tricarboxylic acids cycle deregulation, impaired fatty acids β-oxidation or defective tubular reabsorption.