Naik AS, Le D, Aqeel J, et al. - Researchers undertook this observational analysis among 87 healthy normotensive people who were cleared for living kidney donation, to non-invasively evaluate injury patterns related to mean arterial pressure (MAP). They used urine pellet podocin and aquaporin2 mRNAs normalized to the urine creatinine concentration (UPod:Creat ratio and UAqp2:Creat ratio) as markers of podocyte detachment and tubular injury, respectively. The relative rates of podocyte stress and glomerular compared with tubular injury were estimated by the ratio of two podocyte mRNA markers, podocin to nephrin (UPod:Neph) as well as the ratio of podocin to the tubular marker aquaporin2 (UPod:Aqp2). Experts identified a positive correlation of MAP with the UPod:Neph and UPod:Aqp2, thus corroborating the link of MAP with podocyte stress and the preferential targeting of the glomerulus by higher MAP. Higher podocyte stress and detachment into the urine were shown to be related to MAP even in a relatively “normal” range of MAP. Therefore, the progression risk can potentially be detected, via urine pellet mRNA monitoring, prior to the onset of overt hypertension, proteinuria or chronic kidney disease.