Evaluation of renal function and renal risk in the twenty-first centuryVilla Camozzi, Istituto Mario Negri, via G.B. Camozzi 3, 24020
Ranica (BG) Italy
December 4-5, 2015
Villa Camozzi - Mario Negri Institute, via G.B. Camozzi 3, 24020 Ranica (BG), Italy
DIABESITY Working Group
Local Coordinator/Contact Person for information
Prof. Estaban Porrini, Secretary of the DIABESITY WG
Organising Secretariat: CIBICAN. University of La Laguna
In this CME we will analyze two relevant aspects of renal disease in diabetes and obesity: (a) the evaluation of renal function and (b) novel risk factors of renal disease.
(a) Renal function is frequently assessed by formulas (MDRD, CKD-EPI, etc). However, these formulas have a mean error of ± 30% when compared with a gold standard. This is particularly relevant in diabetes and obesity where formulas fail to detect glomerular hyperfiltration -an early marker of renal disease- and overestimate renal function decline overtime. Thus, in research and in day-to-day clinical practice the evaluation of renal function in patients with diabetes and obesity is neither accurate nor precise. In this CME we will evaluate studies showing the bias in estimating GFR in patients with diabetes and/or obesity. We will try to explain the causes of the error in formlas i.e. the relationship between inflammation and metabolic syndrome with cistatin-c, and the changes in creatinine extretion in CKD and obesity. Also, we will focus on the impact of weight reduction on GFR changes in obesity and whether these changes are reflected by estimated GFR. We will also analyze clinical aspects of renal disease in diabetes and obesity. The relevance of gold standard methods in research i.e. clinical trials will be stressed and the agreement methods to compare estimated and measured GFR will be reviewed. Finally, the impact of estimating GFR in other areas like transplant medicine and drig dosing will be briefly explained.
(b) Albuminuria is a "classic"risk for renal and cardiovascular disease. However, its role as a predictor of renal disease in diabetes has been challenged by the nonproteinuric phenotype of renal function loss that can affect about 30%of the cases of CKD in diabetics.Thus, we need urgently new markers of renal damage in the clinics and in research. We will analyze the relevance of novel parameters of renal damage i.e. inflammatory markers:TNF-alpha, MCP1, IL6, markers of lipotoxicity: liver-type fatty acid binding protein (L-FABP) and urinary free fatty acids and tubular markers: kidney injury marker 1 (KIM-1), acetyl-β-d-glucosaminidasa (NGAL), α1 microglobuline, among others.