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Diabetic Kidney Disease, New Prevention Target Found

Diabetic kidney disease

Diabetic kidney disease, also known as diabetic nephropathy, is a serious complication of both type 1 and type 2 diabetes, affecting up to about 30 percent of individuals with the disease. Preventing kidney damage is a challenge, which is why a new prevention target discovered by scientists could be good news.

Scientists work to prevent diabetic kidney disease

The kidneys contain millions of tiny blood vessels with filters that process waste products. Diabetes can damage this process, as high levels of sugar in the blood, over time, can excessively stress the filtering system and cause leaks.

When the kidneys leak, they release protein into the urine. Small levels of protein in the urine, called microalbuminuria, is a sign of early kidney disease, which can be treated to prevent it from worsening. When kidney disease has progressed to where large amounts of protein are in the urine (macroalbuminuria), end-stage kidney disease usually results and can lead to the need for dialysis or a kidney transplant.

Scientists in Japan have found a new target for diabetic kidney disease in mice, and it's called osteopontin. This molecule is involved in the inflammatory process, and inflammation has been established as playing a key role in diabetic nephropathy, as shown in a number of studies, including a new review in Mediators of Inflammation.

To return to the discovery of the role of osteopontin, the researchers, under the lead of Daisuke Ogawa, MD, PhD, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, explored the effect of inhibiting the activity of osteopontin in diabetic mice that had kidney damage.

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To achieve this goal, the research team used a drug called T0901317 to activate a receptor called the liver x receptor (LXR), which inhibits the expression of genes involved in inflammation. When the diabetic mice were given T0901317, kidney function improved and the expression of osteoponin and other molecules involved in inflammation declined.

In addition, when kidney cells were exposed to high concentrations of sugar, which is characteristic of people with diabetes, the scientists observed an increase in osteopontin expression. Use of T0901317, however, inhibited the inflammatory molecule activity
More about diabetic kidney disease
According to the National Kidney Foundation, about 30 percent of individuals with type 1 diabetes and 10 to 40 percent of those with type 2 diabetes will eventually experience kidney failure. In addition to protein in the urine, other signs of kidney disease in diabetics, include high blood pressure, leg cramps, ankle and leg swelling, need to urinate often during the night, itching, weakness, anemia, morning sickness, nausea and vomiting, and high levels of creatinine in the blood.

If you have diabetes, steps you can take to help prevent diabetic kidney disease include:

  • Maintain a healthy blood sugar level
  • Achieve and maintain a healthy blood pressure, below 130/80 mmHg
  • Have the following tests once a year: urinary albumin test (for protein levels in urine) and blood test for creatinine
  • Avoid chronic use of painkillers such as acetaminophen, ibuprofen, and aspirin, as they can damage the kidneys. Talk to your doctor about daily aspirin use to protect your heart and alternative ways to treat chronic pain, such as arthritis.
  • Do not neglect any signs of kidney or bladder infection, such as burning or pain when urinating, cloudy or reddish urine, pain in the back or side below the ribs, or a frequent urge to urinate.
  • Avoid excessive amounts of protein in your diet; that is, go light on meats, poultry, and dairy
  • There's some evidence chromium may help reduce kidney disease risk

According to Dr. Ogawa, the discoveries in the latest study "support an important role for LXR agonists in suppressing the inflammatory responses in diabetic kidneys and preventing the development of nephropathy." Thus far researchers have not developed a definitive way to prevent diabetic kidney disease, but anyone with diabetes can take preventive steps on their own.

Lim AKH, Tesch GH. Inflammation in diabetic nephropathy. Mediators of Inflammation 2012; article ID 146154. doi:10.1155/2012/146154
National Kidney Foundation
Tachibana H et al. Activation of liver x receptor inhibits osteopontin and ameliorates diabetic nephropathy. Journal of the American Society of Nephrology 2012, online. doi:10.1681/ASN.2012010022

Image: Wikimedia Commons