A recent study from the University of Bristol has uncovered a promising new way to slow down the progression of diabetic kidney disease, a serious condition that affects nearly 40% of people living with diabetes.
This discovery could bring relief to millions, including the 4.8 million people in the UK with diabetes, who face a much higher risk of kidney failure compared to those without the disease. In fact, people with diabetes are up to four times more likely to need dialysis or a kidney transplant due to kidney complications.
Diabetic kidney disease happens when high blood sugar levels gradually damage the tiny blood vessels in the kidneys. These vessels play an important role in filtering waste and extra water from the blood.
Over time, the damage makes it harder for the kidneys to do their job properly, leading to a dangerous buildup of waste in the body. One early sign of this damage is when protein starts leaking into the urine, something that normally shouldn’t happen.
Currently, doctors sometimes use a drug called spironolactone to treat this condition. It’s a medication that’s been around for years and is usually used to lower blood pressure. Clinical trials have shown that spironolactone can reduce the amount of protein leaking into the urine, which suggests it may help protect the kidneys.
However, it’s not without its downsides. One of the most serious side effects is that it can raise potassium levels in the blood too high, which can be dangerous and even life-threatening. Because of this, some doctors are hesitant to prescribe it, especially for long-term use.
The researchers in this new study wanted to find out exactly how spironolactone helps protect the kidneys. They focused on a special layer inside the kidneys called the glycocalyx. This is a thin, gel-like coating that lines the inside of blood vessels and helps protect them from damage.
Think of it like a soft, protective barrier that keeps things running smoothly. In people with diabetes, this layer often gets damaged, which makes it easier for proteins to leak into the urine and for further kidney damage to happen.
To better understand the role of this layer, the scientists used kidney biopsy samples from real patients. They developed a new way to measure how thick or thin this protective layer was.
Their results showed that in people with diabetes, the glycocalyx layer was indeed damaged. But when spironolactone was used, it helped prevent that damage from happening. This gave researchers a clear idea of how the drug works at the cellular level.
They also discovered another interesting detail: spironolactone lowers the activity of a group of enzymes called matrix metalloproteases. These enzymes can break down the glycocalyx layer. So by reducing their activity, spironolactone helps keep the protective layer intact, which in turn protects the kidneys from further harm.
Now that the researchers understand this process better, they are looking into whether other drugs that specifically target those enzymes could also help people with diabetic kidney disease—without causing the same side effects as spironolactone. If they are successful, it could lead to new treatments that are safer and more effective.
For people living with diabetes, this study brings a sense of hope. While researchers continue to work on new treatments, there are still important steps individuals can take to protect their kidney health. Managing blood sugar levels and keeping blood pressure within a healthy range are key.
Eating a balanced diet that’s low in salt and rich in vegetables, fruits, and whole grains also helps. Regular exercise, quitting smoking, and taking prescribed medications as directed are all important ways to lower the risk of kidney damage. It’s also wise to have regular checkups and kidney function tests, so that any problems can be caught early and treated right away.
This study, led by Dr. Matthew Butler and published in JCI Insight, could lead the way to better and safer treatments for diabetic kidney disease in the near future, improving the quality of life for millions of people.
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