Reversing Early Kidney Damage in Diabetics
Patients with type 1 diabetes who have slightly elevated levels of protein in their urine are not necessarily destined to develop kidney failure years later.

In fact, during the study's six-year follow-up period, the condition, known as microalbuminuria, actually regressed in nearly 60 percent of patients with this form of diabetes, who must take insulin to live.
"Microalbuminuria has this label as a dire finding, that kidney disease is inevitable," said study author Dr. Bruce A. Perkins of the Joslin Diabetes Center in Boston, Massachusetts.

But the new findings "give hope that with the right medical care people can get rid of this condition" before it progresses, he says.
When the kidneys, which filter blood, become damaged by diabetes, protein from blood can leak into urine. While doctors have thought this damage was irreversible, Perkins said, the new results indicate it may be repaired in patients who have small protein elevations in the urine that are suggestive of lesser amounts of damage.
Extensive damage leads to kidney failure, which requires that a patient undergo regular dialysis or a kidney transplant.

In the study, published last Thursday in The New England Journal of Medicine, microalbuminuria was most likely to regress in patients who had their blood sugar under tight control and had healthy levels of cholesterol, triglycerides and blood pressure.

The findings suggest that quality medical care that detects microalbuminuria early and addresses these other factors may afford the kidneys an opportunity to heal, Perkins said.
"If one develops microalbuminuria, there are still measures that can be taken to try to reverse it," he said.

The study involved 386 patients who had microalbuminuria during a two-year evaluation period and were then followed for the next six years to see whether the condition persisted. While microalbuminuria regressed in 58 percent of patients, 19 percent developed a more advanced condition called proteinuria, which is marked by higher levels of protein in the urine that signal greater kidney damage.

Statistics show that about half of patients with type 1 diabetes will develop microalbuminuria at some point in their lives, and the odds are even greater for those with type 2 diabetes, according to Perkins.
He said that while the study did not include people with type 2 diabetes, which is the more common form of the disease, the findings could possibly apply to them as well.

"It's likely, but it definitely should be studied," Perkins said.
In an accompanying editorial, Dr. Eberhard Ritz of the University of Heidelberg in Germany writes that the study provides "welcome documentation that a widely accepted surrogate marker for the progression of (kidney) disease can be favorably influenced." NEJM May 29, 2003
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FACT: Two studies reported in the June 5 issue of the New England Journal of Medicine offer hope for those with microvascular complications of type 1 diabetes. The first study shows regression of microalbuminuria with aggressive management of diabetes, and the second shows that intensive therapy can slow the progression of carotid intima-media thickness.

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