In conclusion, urine samples from independent well-characterized cohorts of patients with diabetes identified the UAdCR as a robust predictor of ESKD and mortality independent of albuminuria and baseline eGFR, and spatial metabolomic and single-cell-transcriptomic studies from human kidney biopsies identified a potential role for endogenous adenine and the mTOR pathway in DKD. This evidence concerns the gene MTOR and diabetic kidney disease.