New Clues to Kidney Disease May Improve Diagnosis and Treatment

Researchers are making headway in understanding the cause of kidney failure, a possible complication of diabetes.

This is welcome news considering approximately 33 percent of people with diabetes suffer kidney damage that can progress to end-stage renal disease (ESRD), the final stage of kidney disease in which the kidneys no longer function properly.

The new clues to ESRD come from studying the metabolites of diabetic patients. Metabolites are molecules created during metabolism, the process of digesting food to extract energy.

"Alterations of metabolism in general are key to diabetes, and studies like this may have huge potential for unraveling new pathways which will lead to developing new drugs and new diagnostic tests," said researcher Monika Niewczas, M.D., Ph.D., of the Joslin Diabetes Center.

Following Metabolic Clues

The research used global mass spectrometry to look at plasma samples from diabetes patients:

  • The plasma samples were drawn when the patients were either still kidney-healthy or in early stages of kidney trouble.
  • Scientists analyzed the plasma readings of 40 participants who subsequently developed ESRD – and 40 who did not – during an eight to 12-year follow-up period.
  • Of the 2,400 metabolites measured, 16 of them were found present in significantly higher amounts in those participants who developed ESRD. Scientists call these 16 metabolites “uremic solutes.”

The 16 uremic solute molecules were already known to congregate in blood plasma during kidney failure, but remember, the plasma samples in this study were drawn when most subjects’ kidney function was normal. This suggests that uremic solutes either contribute to early stages of ESRD or are a sign of it.

Researchers also discovered a link between increased concentrations of a metabolite called myo-inositol and ESRD progression. Myo-inositol is involved with several biological mechanisms including insulin signaling.

Looking Forward

For some time scientists have theorized that damage to blood vessels in the kidneys, called glomeruli, was behind progressive kidney disease. When damaged, glomeruli secrete the protein albumin into the urine. However, treatment for excess urine albumin does not prevent ESRD.

That is why researchers are excited to isolate the metabolite indicators for kidney disease. This knowledge may lead to earlier diagnosis of kidney damage and to treatments that effectively slow or stop its progression.

Source: News Medical

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