[Treatment of end-stage diabetic nephropathy]

The progression of diabetic nephropathy can be halted by keeping blood glucose levels close to normal values. Three therapeutic approaches can be considered: intensive insulin treatment, islet of Langerhans transplantation, and pancreas transplantation. 1) The Diabetes Control and Complication Trials, a clinical study conducted from 1983 to 1993, showed that intensive insulin treatment prevented the development and slowed the progression of diabetic kidney disease by 50%. 2) In 2003, P. Fiorina studied the potential effects of islet transplantation on the renal function of 36 patients with type 1 diabetes and kidney transplant. An improvement in kidney graft survival rate and functioning [Na(+)/K(+)-ATP activity] was observed when compared with 12 patients with unsuccessful islet transplant. 3) P. Fioretto et al, in 2006, confirmed that normoglycemia for 10 years following pancreas transplantation alone reversed diabetic glomerulopathy lesions in native kidneys. This study also demonstrated that interstitial expansion was reversible and atrophic tubules were reassorbed. 4) P. Fiorina, in 2007, confirmed that simultaneous kidney-pancreas transplantation was associated with a better high-energy phosphate metabolism (as assessed by 31P-magnetic resonance spectroscopy) than in kidney- alone transplanted diabetic patients, suggesting that restoration of Beta cell function positively affects kidney graft metabolism.