Enlarging our view of the diabetic kidney

Article Abstract:

Kidney failure is a common consequence of diabetes, and, indeed, diabetic nephropathy is the largest single cause of kidney failure in the United States. Nevertheless, little is known about the events that lead the kidney down the path towards failure in the diabetic patient. It is clear that many patients in the early stages of diabetes develop an increase in the rate that fluid filters through the glomerular structures within the kidneys. Many of these same patients also have enlarged kidneys. Although the hypertrophy, or enlargement, of the kidneys is very common among patients with diabetic kidney failure, it is not certain whether the hypertrophy causes the kidney failure or even whether such enlargement is necessary for kidney failure to occur. Nevertheless, the association between kidney enlargement and ultimate failure is strong enough that the factors affecting kidney enlargement are being actively studied. There is indirect evidence that the kidneys may enlarge in response to increased production of ammonia, a metabolic by-product of amino acid metabolism. Considerable research attention has also been paid to the hypothesis that hormones may be involved. While the amounts of insulin-like growth factor I (IGF-I) are not increased in patients with diabetes, the amount of IGF-I produced within the kidneys themselves is increased. In the June 6, 1991 issue of The New England Journal of Medicine, researchers present evidence that the response of kidneys to amino acids and blood sugar control are closely related. They found that amino acids, the primary building blocks of proteins, stimulate an increase in the size of the kidneys in diabetic patients. However, when the same patients were hospitalized and given intensive insulin therapy to closely control their blood sugar, the size of the kidneys returned to normal and further administration of amino acids no longer had the same effect. These findings provide a strong indication of the importance of closely maintaining proper blood sugar levels in patients with diabetes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Diabetes, Diabetes mellitus, Diabetic nephropathies, Kidney diseases, editorial

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The Modification of Diet in Renal Disease study

Article Abstract:

The role of diet in the progress of renal (kidney) disease remains an important question. Previous clinical trials on humans have failed to document clearly if phosphorus- and protein-restricted diets provide adequate nutrition in patients with chronic renal disease while also slowing the progression of kidney failure. The Modification of Diet in Renal Disease Study comprises a four-phase study which addresses the question of dietary management in renal disease. Some Phase II results are available and suggest that dietary management of patients with chronic kidney failure, by skilled nutritionists, can reduce the workload placed on already impaired kidneys, thereby prolonging residual kidney function. No evidence of overt malnutrition was found in the patients who complied with the very-low-protein diets. Thus, further testing of protein-restricted diets appears to be safe. It is hoped that Phase III of the study will provide conclusive data on whether or not protein- and phosphorus-restricted diets benefit renal disease patients, and the effects of strict control of blood pressure and the progression of renal insufficiency.

Health aspects, Research, Diet, Diet in disease, Diet therapy, Chronic kidney failure, column

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Acute oliguria

Article Abstract:

Acute oliguria is a sudden decrease in urine output, and often indicates poor kidney function. The condition may be caused by infection, urinary obstruction, inadequate kidney blood flow, or other conditions, and can be life-threatening. Examination of the urine and blood may indicate the likely cause of oliguria. Many patients will develop infections if the condition persists. Identification and correction of the cause of oliguria is important. Diuretic drugs to increase urinary output may be useful, although kidney dialysis to restore normal fluid balance is a common treatment.

Care and treatment, Medical examination, Acute renal failure, Acute kidney failure, Urination disorders, Urine, Urinalysis

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