TNF receptors 1 and 2 may predict kidney disease in diabetes

Levels of certain blood proteins indicate which diabetes patients will likely develop life-threatening kidney problems in the future, according to two studies appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results could help physicians protect the kidney health of patients with diabetes years before any visible signs of trouble arise.

Kidney failure is one of the most life-threatening complications of diabetes, and almost half of patients who receive dialysis treatments need them because their kidneys have become damaged from diabetes.

Unfortunately, physicians don't have an accurate, non-invasive way to determine which diabetes patients are most likely to develop kidney problems. Because recent research indicates that inflammation may contribute to kidney injury among patients with diabetes, Andrzej Krolewski, MD (Joslin Diabetes Center and Harvard Medical School), Monika Niewczas, MD, PhD (Joslin Diabetes Center, Harvard Medical School, and Medical University of Warsaw, in Poland), and their colleagues wondered whether certain markers of inflammation might signal when a patient's kidneys are in jeopardy.

The investigators measured several dozens of inflammation markers in the blood and urine of more than a thousand patients with type 1 and type 2 diabetes and then monitored the patients' kidney health for more than a decade. They identified two extremely powerful markers—tumor necrosis factor (TNF) receptors 1 and 2—that increased patients' risk of developing kidney disease by three- to five-fold when found at high levels in the blood 10 years earlier. A diagnostic test to measure blood levels of TNF receptors is currently in development and should be available in the clinic soon.

The findings also go beyond prediction and suggest that targeting TNF receptors may be an effective way to prevent or slow kidney function decline. "Learning about mechanisms that regulate blood levels of TNF receptors and the way that high levels of these receptors cause kidney injury will accelerate the search for new therapeutic targets against kidney disease in individuals with diabetes and possibly in those without diabetes," said Dr. Krolewski.

Source: Journal of the American Society Nephrology