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How does the immune system affect diabetic kidney disease?

Researchers reviewed the relationship between the immune system and diabetic kidney disease, and the impact of this potential effect on treatment options.

High blood sugar levels can cause damage to the kidneys. This long-term condition, known as diabetic kidney disease, can progress to end-stage renal disease. Patients with end-stage renal disease usually require dialysis or a kidney transplant to improve renal function. Current research shows there is a connection between inflammation, the immune system, and diabetic kidney disease. Researchers in Ireland recently composed a review of the literature thus far concerning the role of the immune system in diabetic kidney disease and published their findings in the journal Current Diabetes Reports.

The immune system plays an important role

Scientists have found indicators of inflammation in blood samples and the kidney tissue of patients with diabetic kidney disease, with increasing amounts of these indicators as the condition worsened. These inflammatory markers are associated with the presence of protein in the urine.

Some of the parts of the immune system that are involved in diabetic kidney disease include macrophages, T cells, B cells, and mast cells. When the amount of sugar in the kidneys is high, macrophages gather and release molecules that damage the kidneys. This is one of the reasons why the presence of a large number of macrophages has been associated with reduced kidney function in patients with diabetes. While more research is required to determine the role of B cells and T cells in this disease, some studies indicate a possible link. Patients with type 2 diabetes with evidence of protein in the urine were found to have T cells present in their kidneys. Mast cells are also involved in kidney damage.

Treatment options

The currently available data shows that inflammatory markers and the immune system are important factors to consider when developing therapeutic options to manage diabetic kidney disease. Medications that block the production of these inflammatory markers can help reduce the damage done to the kidneys. The accumulation of macrophages is another useful target considered as a treatment option; researchers are conducting studies on medications with different mechanisms of action, such as reducing the accumulation of macrophages in the kidneys. Mast cell stabilizers are also being studied, as they have been found to be beneficial.

Understanding the effects of the immune system on diabetic kidney disease enables researchers to develop more helpful options that clinicians can use in caring for this patient population.

Written by Anuolu Bank-Oni, Pharm.D, CDE, BCGP

Reference: Hickey F, Martin F. Role of the immune system in diabetic kidney disease. Current Diabetes Reports (2018) 18:20



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