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Between hyperfiltration and impairment: demystifying early renal functional changes in diabetic nephropathy
Elizabeth T Rosolowsky1, Monika A Niewczas, Linda H Ficociello
1Research Division, Joslin Diabetes Center, Boston, MA 02215, USA.
Diabetes Research and Clinical Practice
|October 14, 2008
Summary
Diabetic kidney disease may impair renal function before protein in urine appears. Early kidney function decline in type 1 diabetes patients with microalbuminuria suggests new intervention targets.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Traditionally, diabetic nephropathy progression was linked to urinary albumin excretion.
- Hyperfiltration was observed with normoalbuminuria and microalbuminuria, with function loss starting at proteinuria.
- Newer research using serum cystatin-C-based estimates challenges this established paradigm.
Purpose of the Study:
- To investigate the onset of renal function impairment in diabetic nephropathy.
- To determine if renal function declines before proteinuria becomes evident.
- To identify potential mechanisms driving early renal function loss in type 1 diabetes.
Main Methods:
- Utilized serum cystatin-C-based estimates of glomerular filtration rate (cC-GFR).
- Analyzed data from the 2nd Joslin Kidney Study on the Natural History of Microalbuminuria.
- Assessed renal function in type 1 diabetes patients with microalbuminuria at enrollment.
Main Results:
- Over one-third of type 1 diabetes patients with microalbuminuria showed mild (cC-GFR<90 ml/min) or moderate (cC-GFR<60 ml/min) renal function impairment.
- Renal function loss appears to begin prior to the onset of proteinuria, challenging the traditional view.
- Serum uric acid and TNFalpha pathway components are implicated in early renal function impairment.
Conclusions:
- Renal function decline in diabetic nephropathy can precede proteinuria.
- Early detection and understanding of renal impairment mechanisms are crucial for intervention.
- Targeting serum uric acid and TNFalpha pathways may help retard early renal function decline.
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