Joslin Diabetes Center researchers have discovered how the gut hormone GLP-1 protects the kidneys and how it’s rendered ineffective in diabetes. Produced upon eating, GLP-1 increases insulin, inhibits glucagon release, and helps to lower blood sugar. GLP-1 has been shown to improve kidney cell function, preventing kidney damage in an animal model of diabetes. The Joslin researchers found that GLP-1 protects by inhibiting the signaling pathway of Angiotensin II (Ang II), a hormone that contributes to high blood pressure and cardiovascular disease. At the same time, they discovered that high blood sugar in diabetes causes over-expression of an enzyme called protein kinase C-beta (PKC-ß), which increases Ang II and inhibits GLP-1.  The scientists believe that drugs that inhibit PKC-ß and boost the protective effects of GLP-1 could be used to minimize kidney damage and slow progression of diabetic kidney disease.

Source:

New Understanding of Diabetes and Kidney Disease: Findings May Lead to Effective New Treatments, ScienceDaily, July 23, 2012

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A new study from Cleveland Clinic Bariatric and Metabolic Institute suggests that weight loss surgery may improve kidney damage in obese patients with Type 2 diabetes. The researchers followed 52 patients with an average age of 51 years who had lived with diabetes for an average of almost nine years; more than a third of these patients had diabetic kidney disease before bariatric surgery. 84% had hypertension. Using the urine albumin-to-creatinine ratio test to determine kidney function, the researchers found that after five years, 58% percent no longer showed signs of protein in their urine or kidney damage. 42% experienced no change in microalbuminuria. 25% of the patients who had not had signs of kidney damage before surgery did go on to develop albuminuria.

Interestingly, 44% of patients experienced remission of their diabetes and were able to stop taking insulin and in some cases, blood pressure medications. 33% of the patients experienced significant improvement of their diabetes. The researchers determined that the remaining patients with no improvement or worsening of their disease had lost the least amount of weight and had suffered from diabetes for the longest period of time before surgery.

The researchers believe the positive effects of bariatric surgery on kidney health could be due to improvements in blood sugar control and insulin sensitivity as well as reversal of hypertension. According to one expert, a larger study comparing diabetics who did not undergo weight loss surgery is needed to confirm these findings.

Source:

Bariatric Surgery Yields Durable Results for Diabetic Nephropathy, Clinical Endocrinology News, July 9, 2012

Bariatric Surgery May Help Diabetic Kidney Diease, WebMD, June 21, 2012

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Japanese researchers have discovered that NT-proBNP, a biomarker used to detect heart failure, may also predict risk of progressive CKD as well as cardiac risk in patients with Type 2 diabetes. The study followed diabetic patients with stage 1 or stage 2 CKD for 5 years and found that those with a higher baseline of NT-proBNP were more likely to experience a new cardiac event and a 30% decrease in estimated glomerular filtration. The scientists need to conduct more research to confirm an optimal cutoff for levels of NT-proBNP. Because NT-proBNP is already used to test for cardiac risk, the researchers believe it could be an inexpensive and simple way to evaluate diabetic patients in hopes of preventing cardiovascular disease as well as progressive chronic kidney disease.

ADA: Cardiac Biomarker Good for Kidneys, Too, MedPage Today, June 14, 2012

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Diabetes is on the rise in American children and teens. Recent studies from University of Colorado School of Public Health have uncovered a disturbing link between Type 2 diabetes in kids and the risk of early kidney damage. Our infographic below highlights the facts uncovered by the studies.

Source: Diabetes Rising Rapidly Among U.S. Kids, U.S. News & World Report, June 9, 2012

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Let’s wipe out kidney disease together!

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A team of researchers from University of Alberta and University of Florida have shown that angiotensin-converting enzyme-2 or ACE2 can protect against diabetic complications, specifically heart damage, in diabetic mice. Their previous research demonstrated that ACE2 protects the kidneys as well. ACE2 protects by breaking down Angiotensin II, a hormone which contributes to high blood pressure and cardiovascular disease. In the latest study, diabetic mice without ACE2 experienced heart and vascular dysfunction.

The research team plans to study Type 1 and Type 2 diabetics to assess their blood levels of ACE2 and determine whether its protective benefits hold true for humans. Lead researcher, Dr. Gavin Oudit, is currently testing a genetically engineered version of ACE2, which he developed in the hopes of preventing diabetic complications of the kidneys, eyes and heart.

Sources:

An Ace in the Hole for Treating Diabetes, University of Alberta, May 16, 2012

Loss of Angiotensin-Converting Enzyme-2 Exacerbates Diabetic Cardiovascular Complications and Leads to Systolic and Vascular Dysfunction, Circulation Research, April 3, 2012

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Researchers at Harvard Medical School and Joslin Diabetes Center have discovered that high levels of tumor necrosis factor (TNF) receptors found in the blood of patients with Type 1 and Type 2 diabetes may predict incidence of chronic kidney disease and kidney failure years later. TNF proteins can trigger inflammation, which has been linked to the development and progression of diabetic kidney disease, but the researchers don’t know if this is the reason why TNF receptors are increased in some patients. They hope to learn more about the connection, which could result in a diagnostic test and improved therapies for high-risk diabetes patients.

Source:

Proteins May Warn of Diabetic Kidney Disease Risk, Science News, February 11, 2012

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Researchers at the University of Texas Health Science Center San Antonio may have discovered an important medical use for hydrogen sulfide, the toxic, colorless gas that smells of rotten eggs. Their experiment focused on kidney cells exposed to high glucose levels. In diabetes patients, prolonged, uncontrolled blood glucose levels can lead to scarring of the kidneys. The UT researchers found that introducing hydrogen sulfide to the kidney cells resulted in decreased production of damaging proteins that cause kidney scarring. Interestingly, the human body produces small amounts of hydrogen sulfide naturally. The researchers reported that mice with Type 1 and Type 2 diabetes produce fewer kidney enzymes known to aid in the production of hydrogen sulfide. Future research will be needed to determine whether the gas, which is poisonous in higher concentrations, can be used safely and effectively in animals and humans.

Source:

Hydrogen Sulfide Reduces Glucose-Induced Injury in Kidney Cells, Science Daily, January 3, 2012

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The UN summit on non-communicable diseases taking place 17 days from now in New York may not be on every American’s radar, but it should be. The ambitious meeting aims to tackle the alarming rise of chronic diseases affecting the world’s population, particularly in developing nations – cancer, respiratory disease, cardiovascular disease, and diabetes. Everyone knows someone suffering from one of these diseases. Many argue that obesity should be included in this list, and it should be. Perhaps it deserves its own special high-level meeting. Chronic kidney disease should be listed, too, but if the world’s nations can manage to reduce the number of people developing high blood pressure and diabetes, they will prevent many cases of CKD.

This summit will be a start, but there is still a lot of work to be done. The proclamation outlining the details for preventing and controlling these diseases is still in draft form. And there have been no goals set for reducing the number of preventable deaths. Nations are at odds on the important issues of reducing tobacco and salt consumption. Norway’s proposal to set a salt reduction target of 5 grams per person per day worldwide by the year 2025 has been removed from the Outcome Document. This is disheartening. To get some perspective, the average American diet contains 12 to 14 grams of salt per day. Reducing salt to about a teaspoon a day would mean fewer strokes, fewer heart attacks, fewer deaths, fewer cases of hypertension, and by implication, fewer instances of chronic kidney disease. A recent study on salt published in the British Medical Journal showed that reducing salt intake by 3 grams per day in the U.S. “…would result in up to 120,000 fewer cases of coronary heart disease, up to 66,000 strokes and up to 99,000 heart attacks annually.” The NCD Alliance estimates that “…reducing global salt consumption by just 15% through mass-media campaigns and reformulation of processed foods and salt substitution could prevent an estimated 8.5 million deaths in just 10 years.”

The EU, Australia, Japan, the United States, and Canada currently oppose Norway’s salt target. The global group World Action on Salt and Health (WASH) recently issued a press release urging those nations to reconsider their position on salt reduction. News stories about the reasons behind the attempts to block reductions in salt, as well as sugar and fat have appeared in the Canadian press, but the media in the U.S. has yet to pick up on the story. It could be because Hurricane Irene and the unstable economy have dominated our recent news. However, one could argue that becoming a healthier nation in a healthier world would help our economy by saving money in the long run.

As this story evolves, we’ll keep you updated. Let’s hope the EU, Australia, Japan, the United States, and Canada reverse their position on salt. Stay tuned!

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Metabolic syndrome describes a set of symptoms that increases the risk of Type 2 diabetes, heart disease, and stroke. Those risk factors are:

• high blood pressure
• obesity, particularly extra weight around the waist
• insulin resistance
• low good cholesterol
• higher levels of triglycerides

Patients are diagnosed with metabolic syndrome when they have 3 or more of these symptoms.

There have been a number of interesting discoveries about metabolic syndrome in the news lately. Scientists have found a link between metabolic syndrome and kidney disease which could lead to early interventions to prevent the syndrome as well as diabetes and kidney disease. – Metabolic Syndrome May Cause Kidney Disease

Researchers from the Gladstone Institutes have discovered how a gene called SIRT3 increases the risk of metabolic syndrome. – Gene That Exacerbates Risk Factors for Heart Disease and Diabetes Identified

Metabolic syndrome is also associated with increased incidence of kidney stones. An article from Internal Medicine News provides some insight into statistics and a possible cause for kidney stones in obese individuals. – Kidney Stones Linked to CVD, Metabolic Syndrome

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Recent stories about older living kidney donors, including some with medical issues, are truly inspiring and encouraging given the organ shortage. In an interesting article, Stephen Textor, M.D., Professor of Medicine at Mayo Clinic, describes his experience with donors with moderate essential hypertension, who would normally be excluded from donating. - Medical Abnormalities Need Not Exclude Middle-Aged Kidney Donors

In this amazing story, a 59-year-old man who once suffered from diabetes, was tested and cleared to donate a kidney to his brother. The two turned out to be identical twins, so there is no need for a lifetime of immunosuppressant drugs. – Diabetic Brothers Complete Triathlon

A 66-year-old-donor participates in a new robot-assisted transplant operation in this video report. – Robot Assists AGH Surgeon During Kidney Transplant

And here are two wonderful stories about healthy donors in their 60′s. – Tampa Nuns Say It’s a Miracle Kidney Donation Fit and Paired Kidney Donations Save Two Lives, Enrich Two Others

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