A Decade Ahead of Kidney Damage

Kidney failure risk in type 1 and type 2 diabetes patients indicated by TNF receptor levels

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Unfortunately, a good deal of diabetes patients will suffer from kidney disease. While kidney damage may be one of the more deadly complications of diabetes, it is also preventable - especially if it is spotted early.

Researchers have found two new markers that can predict the risk of kidney damage in patients with type 1 and type 2 diabetes as much as ten years beforehand.

This discovery may soon lead to an accurate and easy-to-use tool for the early identification of people at high risk of kidney damage.

"Ask your doctor about blood tests that identify risk of kidney damage."

In two recent studies, Andrzej Krolewski, M.D., Ph.D., of the Joslin Diabetes Center, and colleagues identified a way to predict the risk of kidney damage in people with diabetes by measuring levels of two substances called tumor necrosis factor receptor 1 (TNFR1) and tumor necrosis factor receptor 2 (TNFR2).

Kidney damage is a serious and potentially deadly problem for many diabetes patients. Over time, kidney damage can lead to kidney failure, or end-stage renal disease - a condition that requires dialysis treatment or a kidney transplant. Diabetes is the cause of almost 44 percent of cases of end-stage renal disease in the United States.

At the moment, there is no noninvasive test that can accurately spot patients who face a high risk of end-stage renal disease.

From their first study, which involved 410 patients with type 2 diabetes, the researchers found that type 2 diabetes patients at risk of end-stage renal disease (total or near-total loss of kidney function) had high levels of TNFR1 and TNFR2 in their blood.

That finding led the team to their second study, which involved 628 patients with type 1 diabetes. The researchers wanted to see if TNFR1 and TNFR2 could not only predict total kidney failure, but also predict the risk of a decline in kidney function. That is, could these two markers be early signs of kidney damage before it starts?

The study's results show that high levels of TNFR1 and TNFR2 increase the risk of kidney damage by three to five times.

"High levels of TNFR1 and TNFR2 enable the prediction of [kidney] failure ten years in advance, similar to the way high levels of cholesterol provide an early warning of increased risk of cardiovascular complications," explains Monika A. Niewczas, M.D., Ph.D., of Joslin Diabetes Center and a leading author for both studies.

When the researchers started their studies, they measured many different markers of inflammatory disease in over a thousand diabetes patients. TNFR1 and TNFR2 stood out from the other markers, such as blood pressure and blood sugar, which are currently used by doctors to predict kidney damage risk.

The researchers do not know how these two protein receptors contribute to kidney damage. If it turns out these markers play an active role in kidney damage, additional research may also lead to new drugs that target TNFR1 and TNFR2.

“A diagnostic test to measure TNFRs in blood will be developed soon and available for patients,” says Dr. Krolewski. “In the meantime, our findings suggest that mechanisms underlying the association between TNFRs and high risk of renal function decline may be a target for new drug development.”

Both studies appear in the Journal of the American Society of Nephrology, and were supported in part by the National Institutes of Health and the Juvenile Diabetes Research Foundation.

Reviewed by: 
Review Date: 
January 24, 2012
Last Updated:
January 25, 2012