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Related Experiment Videos

Diabetic nephropathy: the proteinuria hypothesis.

Mark E Williams1

  • 1Joslin Diabetes Center, Harvard Medical School, Boston, Mass., USA. mark.williams@joslin.harvard.edu

American Journal of Nephrology
|March 5, 2005
PubMed
Summary

Proteinuria is a key indicator in diabetic kidney disease. Reducing proteinuria may slow disease progression, supporting its use as a surrogate endpoint in clinical trials for diabetic nephropathy.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Trials

Background:

  • Proteinuria is a universal finding in progressive kidney disease.
  • It is a hallmark and predictor of diabetic nephropathy progression.
  • Microalbuminuria is an early predictor of diabetic glomerulopathy progression.

Purpose of the Study:

  • To critically review diabetic proteinuria, including mechanisms, natural history, and treatment trials.
  • To address the validity of the 'proteinuria hypothesis' in diabetic nephropathy.
  • To analyze the role of renin-angiotensin blockade in managing diabetic nephropathy.

Main Methods:

  • Critical review of the literature on diabetic proteinuria.
  • Analysis of molecular mechanisms and natural history of diabetic nephropathy.
  • Evaluation of data from treatment trials, including renin-angiotensin blockade.

Main Results:

  • The proteinuria hypothesis posits that higher proteinuria predicts kidney function loss.
  • Proteinuria reduction correlates with slowed disease progression.
  • Proteinuria is proposed as a surrogate endpoint for clinical trials in diabetic kidney disease.

Conclusions:

  • Diabetic nephropathy serves as a model for using proteinuria as a surrogate marker.
  • Prospective data from further clinical trials are needed to confirm this.
  • Additional trials, especially those using non-renin-angiotensin blocking drugs, are crucial.

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