A groundbreaking study conducted by the University of Texas has introduced a novel test capable of accurately predicting kidney failure in diabetic patients five to ten years in advance. This discovery provides crucial time for preventive treatment and helps to avoid the need for kidney dialysis .
Aug. 24 (UPI) — Recent research has shown that small metabolic molecules naturally produced in the kidney serve as more reliable predictors of future kidney failure in diabetic patients than the conventional warning sign of protein in the urine. These molecules, particularly adenine, offer the potential for earlier diagnosis and treatment.
A global study led by the researchers at the University of Texas Health Science Center at San Antonio and published in the Journal of Clinical Investigation on Thursday demonstrated that higher levels of adenine, a metabolite produced in the kidney, in urine can predict and cause progressive kidney failure in patients with diabetes.
The study employed a kidney biopsy technique developed by UT Health San Antonio, allowing researchers to identify the locations of adenine and other small molecules in kidney tissues. This method facilitated the classification of cells as either healthy or diseased based on the presence of adenine.
The results revealed that adenine accumulated around scarred blood vessels and damaged tubular-shaped kidney cells. Additionally, high levels of adenine were associated with all-cause mortality, indicating that this metabolite has systemic effects on the body.
The study encompassed 1,200 patients from three different ethnic groups in the United States, along with a separate study including American Indian participants. Furthermore, a cohort composed mainly of Chinese, Asian Indian, and Malay populations in Singapore was evaluated.
The correlation between high urine adenine levels and an increased risk of kidney failure was consistent across all the study populations.
This research is particularly significant because the traditional method of testing urine for protein, or albumin, proves ineffective in nearly half of diabetic patients who ultimately develop kidney failure. These patients exhibit low levels of protein in their urine, providing inadequate indication of their true risk profile.
Considering that over 37 million people in the United States alone, representing approximately 90% of diabetics, have an elevated risk of kidney failure despite having low albumin levels in their urine, this study lays the groundwork for identifying patients five to ten years before kidney failure occurs. Dr. Kumar Sharma, senior study author and professor and chief of nephrology at UT Health San Antonio, emphasizes the importance of this breakthrough in patient care.
“Many diabetic patients are aware of their kidney disease risk, but if they do not excrete enough protein in their urine, they may falsely believe that they are protected,” says Sharma. “However, in many cases, the disease progresses undetected, making it much more challenging to protect the kidneys and prevent dialysis.”
The research team successfully isolated a small molecule that can potentially block the major pathway of adenine production using a newly formulated medication. When tested on mice with type 2 diabetes, this drug significantly reduced kidney adenine levels and protected against various aspects of diabetic kidney disease without affecting blood sugar.
“This study is remarkable since it could pave the way for precision medicine in treating diabetic kidney disease at its early stage,” Sharma explains.
Patients who reach a critical stage of kidney failure require dialysis, wherein they must undergo a procedure to fit a fistula or catheter and spend four hours on a dialysis machine three times a week to purify their blood. According to Sharma, four out of ten diabetics with kidney failure do not survive beyond five years, highlighting the urgent need for new therapies.
“By identifying patients early on and developing therapies targeting adenine and kidney scarring, we hope to either prevent kidney disease or significantly prolong the lifespan of the kidneys,” Sharma concludes.
The study received funding from the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases.
