Proteins May Warn of Diabetes Kidney Disease Risk

Scientists have spotted a link between the presence of certain proteins and an increased risk of kidney disease in diabetic patients.  The discovery could lead to better and earlier predictions of renal failure in patients, perhaps years before they show any symptoms.

Diabetes, which occurs in two common forms, type 1 and type 2, is the commonest single cause of kidney failure, accounting for as an example 44% of cases diagnosed in 2008.  Kidney disease occurs in diabetes when high blood glucose levels damage these vital organs, which excrete harmful substances produced by digesting and metabolizing food and expel them from the body via the bladder.  Without working kidneys we would slowly poison ourselves with the build up of urea and other unwanted substances in our bloodstreams.

While blood dialysis can help patients with kidney failure, it is not an ideal solution, involving the patient in many hours of treatment and often much traveling to get to the clinic every day or so.  In addition, transplant surgery, the best remedy in clinical terms, relies on finding a suitable donor organ and on potentially risky and lengthy surgery.

Two studies carried out by scientists atHarvardMedicalSchoolandBoston’sJoslinDiabetesCenteridentified the link between two proteins found in inflammation called tumor necrosis factor.  TNF was found to be present in high levels in patients who later presented with diabetic renal disease – as late as 12 years after the original readings.  Both type 1 and type 2 diabetics showed the same high TNF levels before developing kidney disease, said the researchers.

The studies involved tracking the health of people with diabetes for up to 12 years, with the patients providing blood samples and answering surveys on their health over the study period.  The first study took in 410 people diagnosed with type 2 diabetes in the 1990s, and found that 54% of those with high levels of TNF went on to develop kidney disease and need dialysis or a kidney transplant.  Controlling for various factors the researchers concluded that those with high TNF were around six times more likely to get kidney failure.

The second study was of type 1 diabetics, and 628 of these were monitored during follow-ups.  Again, the team found that high levels of TNF seemed to result in an increased risk of developing kidney disease – in this case, patients were three times as likely to get this.

TNF proteins work by binding with counterpart receptors to send signals to cells to perform functions in the body, and they are associated with inflammation.  TNF receptors are also found swimming freely in the blood, so that a blood test will show them up and even measure their levels. Scientists do not yet understand why their levels increase in some conditions, but inflammation itself plays a part in both of the commoner types of diabetes, despite their different causes.

The scientists reported their findings in the journal Nephrology, saying they hoped development of a diagnostic test for the TNF proteins could be the next step.

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