Throughout the month of March, the Joslin Blog is highlighting stories about your kidneys and diabetes. Be sure to check in each week for updates from Joslin’s clinicians and researchers on how they are working to help detect and treat kidney disease. This article originally appeared on March 13, 2015.
Diabetic kidney disease is perceived as the most serious long-term complication that inflicts the highest burden on people with type 1 diabetes. Approximately 10-15 percent of patients with kidney complications develop end-stage renal disease (ESRD), meaning that they need dialysis or a kidney transplant to survive. Current treatment methods rely on the proteinuria centered model, which utilizes the amount of protein in a patient’s urine to determine risk and treatment for kidney disease.
Despite the implementation of reno-protective therapies, drugs that reduce the amount of protein in urine, ESRD is still a prominent risk for people with type 1 diabetes, which is why Andrzej Krolewski, M.D., Ph.D., Head of the Section on Genetics and Epidemiology and Associate Professor of Medicine at Harvard Medical School, is implementing a new approach towards fighting ESRD. Dr. Krolewski’s approach focuses on the slope – or the rate at which renal function decline occurs – of renal function to assess and search for new therapies to treat ESRD.
This new approach derives from research in Dr. Krolewski’s lab that shows proteinuria, or protein in a patient’s urine, is a symptom of kidney disease, but not the cause or predictor of kidney disease. Their research also demonstrated that proteinuria will not necessarily occur if a patient has kidney disease. Dr. Krolewski concluded that the actual underlying cause of ESRD is declining renal function and proteinuria is merely a symptom that can accompany kidney disease in various degrees.
These findings defy the proteinuria centered model that has been used for the last 150 years, and illustrate that physicians have been approaching diabetic kidney disease from the wrong angle. According to Dr. Krolewski, to properly address diabetic kidney disease, physicians need to conduct clinical trials that measure the slope of renal function over several years. Continue reading –>