A new study led by scientists at Duke-NUS Medical School and elsewhere has identified disrupted kidney metabolism as a significant contributor to progressive kidney injury in diabetic kidney disease (DKD).
The findings, published in Kidney International, offer insights into the metabolic abnormalities associated with kidney damage in diabetes and suggest improved ways to detect the risk of kidney failure in individuals with DKD.
Background
DKD is a leading cause of kidney failure in Singapore, with approximately nine people diagnosed with kidney failure daily.
Long-term diabetes can lead to kidney disease in up to 40 percent of affected individuals.
This study is part of the Diabetes Study in Nephropathy and other Microvascular Complications (DYNAMO), a global collaborative effort involving researchers and clinicians from 25 institutions across six countries, aimed at reducing the prevalence of DKD.
Key Findings
The research team conducted experiments on a preclinical model and analyzed clinical data and samples from a cohort of 230 patients with type 2 diabetes in Singapore.
They discovered abnormal metabolism resulting in the accumulation of lactate, a byproduct of cellular energy production, which appeared to stem from impaired mitochondrial function in kidney tubule cells.
Lactate levels were closely associated with albumin in the urine, a marker of kidney damage, suggesting that lactate may serve as a distress signal linked to high protein levels in the urine.
Treatment with angiotensin receptor blockers (ARBs), a common therapy for DKD, reversed metabolic abnormalities and prevented kidney injury in the preclinical model.
Among the patients, those with the highest urinary lactate levels faced a significantly increased risk of eventual kidney failure.
Implications
The study suggests that monitoring urinary lactate levels could help predict prognosis and guide the management of DKD. Optimizing kidney energy metabolism may also be crucial for slowing disease progression.
By identifying specific defects in renal energy pathways related to DKD, this research paves the way for precision interventions that target the underlying causes of the disease.
The researchers plan to conduct follow-up studies to investigate whether lactate itself might be a cause of kidney injury.
If successful, these studies could lead to novel therapeutic approaches for preventing DKD by reducing kidney lactate generation or blocking its effects.
Conclusion
This study highlights the significance of disrupted kidney metabolism as a driving force behind progressive kidney disease in diabetes.
It underscores the importance of combining basic science approaches with translational research to uncover mechanistic pathways in major health conditions such as diabetic kidney disease.
These insights could ultimately contribute to the development of innovative prevention and treatment strategies for DKD.
If you care about kidney health, please read studies about drug that prevents kidney failure in diabetes, and drinking coffee could help reduce risk of kidney injury.
For more information about kidney health, please see recent studies about foods that may prevent recurrence of kidney stones, and common painkillers may harm heart, kidneys and more.
The research findings can be found in Kidney International.
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