For decades, kidney care has depended on two main tests: serum creatinine and the estimated glomerular filtration rate (eGFR), often alongside a urine protein check. They are cheap, widely available and useful. They also have a basic limitation: they usually show abnormal results only after the kidneys have already lost a meaningful amount of function.
Precision nephrology aims to change that. Its goal is to understand why a particular patient’s kidneys are failing, predict who is at risk before damage appears, and match each patient to the treatment most likely to work for them.
Beyond creatinine
Standard markers such as eGFR reflect loss of function but are not sensitive enough to detect early damage. Researchers are now studying blood and urine for molecular signals of stress in the kidney long before creatinine rises.
India is contributing to this work. A study led by IIT Bombay with Osmania Medical College, Hyderabad, used metabolomics, the study of small molecules in the blood, to find biochemical patterns that could flag diabetic patients at risk of kidney complications. The team identified seven metabolites that rose steadily from healthy people to people with diabetes to those with diabetic kidney disease. Their longer-term goal is a test based on dried blood spots from a simple finger prick. For a country with more than 101 million adults living with type 2 diabetes, a cheap early-warning test like this could make a major difference.
Genes and risk
Genetics is the second part of precision nephrology. KDIGO has highlighted the role of genetics in classifying and managing CKD, and it recommends genetic testing to improve diagnostic accuracy and support personalised care. Many patients labelled with “CKD of unknown cause” may actually have an inherited kidney condition that can be identified. That changes how their disease is treated and how their relatives, including potential kidney donors, are counselled.
Research is also getting more specific. In 2026, a new proteomic risk score was developed to identify which carriers of high-risk APOL1 gene variants are most likely to develop progressive kidney disease. Not every carrier gets sick, and this kind of tool helps doctors focus their attention where it is most needed.
Treating the cause, not just the damage
Biomarkers are also changing treatment choices. In glomerular diseases such as IgA nephropathy, nephrologists are discussing earlier diagnosis, treatment sequencing, new biomarkers and a revised definition of remission. The broader direction in nephrology is toward precision medicine and therapies that slow or change the course of disease, rather than simply managing kidney failure once it arrives.
The road ahead
Precision tools will only matter if patients can actually get them. Genetic and molecular tests are still expensive and largely limited to large urban centres. Making precision nephrology useful across India will require affordable tests, trained specialists and clinical data drawn from Indian patients rather than borrowed from Western populations.
The goal is simple. Instead of discovering kidney disease when it is already advanced, doctors want to identify it early and understand its cause well enough to stop its progress.
