Science & Technology, UK (Commonwealth Union) – Diabetes can impact various parts of the body from the limbs that can result in peripheral artery disease (PAD) that can lead to amputations and the kidneys. As time goes by, high blood sugar levels may lead to the damage of blood vessels in the kidneys, that can bring about diabetic nephropathy. This condition can progress to kidney failure, which is also known as end-stage renal disease (ESRD).
In healthy kidneys, tiny blood vessels filter waste products from the blood and remove them from the body in the form of urine. In diabetic nephropathy, high blood sugar levels can damage the blood vessels in the kidneys, making it harder for the kidneys to filter waste products effectively. As a result, waste products build up in the blood, which can lead to a range of symptoms and health problems.
When diabetic nephropathy is not treated in time it can lead to kidney failure, which can have severe negative effects on the overall health. In kidney failure, the kidneys are unable to filter waste products from the blood effectively, that can result in a buildup of toxins in the blood. This can cause a range of serious health problems, including heart disease, nerve damage, and anemia.
Lowering the risk of diabetic nephropathy, usually involves the management of blood sugar levels effectively.
A new method to lower progression of diabetic kidney disease, affecting 40 percent of people with diabetes, has been discovered by researchers from the University of Bristol who led the study published this month in JCI Insight. Researchers indicate that this may assist the 4.8 million individuals with diabetes in the UK who have a 4 times higher chance of requiring either dialysis or a kidney transplant.
Recent studies indicate that a common blood pressure medicine, Spironolactone, is effective in lowering the protein leak into the urine. In spite of its positive impact researchers indicate that the drug can have adverse side effects, such as high blood potassium levels in patients, leading to less doctors recommending it.
Bristol Medical School researchers who worked together with international colleagues, set out to learn how spironolactone prevents damage to the kidneys.
They discovered that the drug has a protective effect that assists in preserving the gel-like glycocalyx layer surfacing the blood vessels in the kidney. With the application of novel alternative therapeutics to lessen the speed of glycocalyx layer degradation in diabetes directly may now assist researchers recreate the same effect minus the adverse side effects.
The team conducted the research with patient kidney biopsy specimens to form a novel method to measure glycocalyx depth alterations to verify that diabetes leads to the destruction of the endothelial glycocalyx layer, and spironolactone blocks this damage.
The findings indicated that spironolactone lessens the activity of a group of enzymes, known as matrix metalloproteases, assisting them to preserve the gel-like glycocalyx layer on the surface of the blood vessels in the kidney, halting disease progression.
Dr Matthew Butler, Joint senior author of the study and Consultant Senior Lecturer and MRC Clinician Scientist at the University of Bristol and Honorary Nephrology Consultant at North Bristol NHS Trust (NBT) says “This study is really exciting for us because it confirms that blocking mineralocorticoid receptors using spironolactone preserves kidney function by acting on the glycocalyx.”
“Our next steps will be to look at repurposing drugs that target matrix metalloproteases enzymes [MMPs] to see if they could be of benefit in patients with kidney disease and avoid the troublesome side effects associated with mineralocorticoid receptor blockers. If we see that same level of protection using these more specific drugs, then patients will see significant benefits whilst avoiding the risks associated with high blood potassium levels.”
