Diabetic Kidney Failure May Have a New Source to Blame

We're looking at you, podocytes

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

Any way you look at it, kidney failure is one of the more dire consequences of diabetes.

But scientists have discovered a possible new cause for this common and serious diabetic complication, which may lead to more effective treatments.

Diabetic kidney failure was previously thought to be caused by toxic effects of high blood-sugar levels on kidney cells, and that may still be true, but a new study reported recently in Cell Metabolism suggests insulin’s effect on a group of specialized cells known as podocytes may also play a key role in kidney failure.

"We've found that when you lose insulin signaling in the podocytes, the [blood] filter is not maintained," said Richard Coward of the University of Bristol. “Insulin action on the podocyte is really important to kidney function."

Podocytes are remarkable cells – “a massive cell body with processes extending from them,” according to Coward’s description – that each resemble an octopus. The cells form a structure that is essential to preventing albumin proteins from leaking out of the bloodstream into urine. (Just a heads up: that leakage may indicate kidney disease, which usually progresses over time.)

These podocytes were shown to move actively and “remodel” themselves in genetically engineered mice. Coward figures this so-called remodeling stems from a need for the cells to brace themselves “for an increased workload after a meal.”

Knowledge is power

This may all sound frightening, but the good news is there is evidence suggesting insulin-sensitizing drugs protect against kidney disease in diabetic animals. And since today’s super-sensitive urine tests are capable of detecting the first signs of kidney disease, that means you can stay on top of your kidney function (with a little help from your medical provider).

Thankfully your role doesn’t begin and end with sophisticated medical tests, medication and/or doctor recommendations. There are a number of ways you can impact the health and stamina of your kidneys.

Other recent studies suggest keeping blood pressure in check reduces likelihood of kidney-disease progression, and strength training, of all things, can help combat the effects of kidney disease and failure. Improved muscle mass can lead to better clinical outcomes and greater survival in dialysis patients, according to recent research from UCLA.  (Just stay away from steroids, which have been shown to damage kidneys and spur a host of health-compromising side effects.) Of course, if you’re diabetic, keeping insulin levels in check is vital, since still toxic blood-sugar levels can damage kidneys.

Symptoms of chronic kidney disease (CKD) include lethargy, trouble concentrating, muscle cramping at night, swollen feet and ankles, eye puffiness and dry, itchy skin. You are much more likely to develop CKD if you have high blood pressure, diabetes or a family history of the disease.

All this talk of podocytes and insulin-levels aside, the solution is simple, really. Hit the gym, visit your doctor, and stay away from those office Krispy Kremes to get a leg-up on better kidney health.

By Kyle Smith 



Review Date: 
November 2, 2010