Kidney biopsy tissue and biospecimens (urine, plasma) are used to generate multiple types of molecular data, including single-cell transcriptomics, mass spectrometry imaging-based spatial metabolomics, and urine and plasma. These multimodal data are integrated using bioinformatic analysis to validate metabolites, cell types, and pathways. The pathways and biomarkers are then studied in experimental models to validate the target and allow for early-stage drug development. Finally, the novel biomarker is translated into mechanistic-based interventional clinical trials for clinical development of new DKD therapeutics. The UAdCR mechanistic biomarker could be used to stratify patients who are in the early stage of disease but at high risk for disease progression, to identify relevant subgroups of patients who are more likely to benefit from the targeted therapy for enrollment in clinical trials, and as a measure of target engagement in interventional trials of emerging therapeutics. DKD, diabetic kidney disease; HK-2, human kidney proximal tubular; MTAP, methylthioadenosine phosphorylase; MTC, murine kidney proximal tubular epithelial; mTOR, mammalian target of rapamycin; RNP, ribonucleoprotein; SGLT2i, sodium-glucose cotransporter-2 inhibitor; UAdCR, urine adenine/creatinine ratio.