Kidney disease is a common complication for those living with diabetes and a leading cause of end-stage renal disease, other illnesses and death.  Not all individuals who have diabetes, including those diagnosed at an early age, develop kidney disease.   To understand why some individuals get kidney disease while other do not, a recent study by Diabetes Action Canada Investigators, Dr. Bruce Perkins and Dr. David Cherney in JCI  investigates the role of the renin-angiotensin-aldosterone system (RAAS) – a hormone system that regulates blood pressure and fluid balance.

The function of the kidney is to filter waste products from the blood, by removing them in the urine.  In people with diabetes, higher than normal blood glucose levels over a period of time can damage the blood vessels in the kidneys. If these blood vessels are not functioning properly than the kidney is unable to filter toxins effectively and this can lead kidney disease.  If left untreated, this can lead to kidney failure and the need for either dialysis or a kidney transplant.

In this study, 75 people living with prolonged type-1 diabetes (T1D) and 75 people living without diabetes were tested before and after RAAS stimulation.  Of the individuals with T1D and no signs of kidney damage RAAS activity was comparable to individuals without diabetes.  Conversely, individuals with diabetes and signs of kidney disease had higher levels of RAAS hormone activity causing the the arteries that supply blood to the kidney to constrict.  This study outcome could suggest that that RAAS activation could be an important marker for kidney dysfunction, especially in patients with long-term diabetes.

This work was supported by JDRF and the Toronto General & Western Hospital Foundation.

Lovshin JA, Boulet G, Lytvyn Y, Lovblom LE, Bjornstad P, Farooqi MA, Lai V, Cham L, Tse J, Orszag A, Scarr D, Weisman A, Keenan HA, Brent MH, Paul N, Bril V, Perkins BA, Cherney DZ.
Renin-angiotensin-aldosterone system activation in long-standing type 1 diabetes (link is external). JCI Insight. 2018 Jan 11. doi: 10.1172/jci.insight.96968