A growing number of patients are recognised to have chronic kidney disease 
(CKD). However, only a minority will progress to end-stage renal disease 
requiring dialysis or transplantation. Currently available diagnostic and 
staging tools frequently fail to identify those at higher risk of progression or 
death. Furthermore within specific disease entities there are shortcomings in 
the prediction of the need for therapeutic interventions or the response to 
different forms of therapy. Kidney and urine proteomic biomarkers are considered 
as promising diagnostic tools to predict CKD progression early in diabetic 
nephropathy, facilitating timely and selective intervention that may reduce the 
related health-care expenditures. However, independent groups have not validated 
these findings and the technique is not currently available for routine clinical 
care. Furthermore, there are gaps in our understanding of predictors of 
progression or need for therapy in non-diabetic CKD. Presumably, a combination 
of tissue and urine biomarkers will be more informative than individual markers. 
This review identifies clinical questions in need of an answer, summarises 
current information on proteomic biomarkers and CKD, and describes the European 
Kidney and Urine Proteomics initiative that has been launched to carry out a 
clinical study aimed at identifying urinary proteomic biomarkers distinguishing 
between fast and slow progressors among patients with biopsy-proven primary 
glomerulopathies.