The Problem of Diabetic Kidney Disease
In people with diabetes, blood sugar levels are higher than normal. Over time, the high blood sugar can damage the kidneys. If this happens, waste and fluids build up in the blood instead of being filtered out of the body by the kidneys.
Kidney damage from diabetes (known as diabetic nephropathy) begins without symptoms. Early signs are increases in serum creatinine (detected by a blood test) or increased amounts of albumin or protein in the urine (detected by urine tests).
If the damage continues, the kidneys may fail and result in the need for dialysis or kidney transplant. In fact, diabetes is the most common cause of kidney failure in the United States. This may happen in up to 15% of people with type 1 diabetes.
The Need for New Therapies
Controlling blood sugar and blood pressure can slow down kidney damage or keep it from getting worse. Use of certain blood pressure medicines, such as ACE inhibitors (for example, lisinopril or ramipril), may also help protect kidney function in people with diabetes. However, despite these approaches, the risk of kidney failure in type 1 diabetes remains, and new treatments are urgently needed.
Recent research has shown that people with type 1 diabetes who have blood uric acid levels higher than average are at increased risk of losing kidney function. Therefore, a promising approach is to use treatments to lower the level of uric acid in the blood. Researchers believe that reducing uric acid levels using a drug called allopurinol (used for many years as a treatment for gout) may help protect kidney function. Promising results have been seen in a few small studies, but these need to be confirmed by larger studies that include more people carefully followed over a longer period of time.
The PERL Study
The Preventing Early Renal Loss (PERL) in Diabetes Consortium is a group of researchers from North America and Europe who have come together to find new ways to prevent diabetic kidney disease. As our name says, PERL is especially committed to finding treatments that are helpful at an early stage, when most of the kidney function is still intact.
The PERL Consortium has been funded by the US National Institutes of Health (NIH) and the Juvenile Diabetes Research Foundation (JDRF) to conduct a large international study to see whether lowering serum uric acid using a medication called allopurinol may help prevent or slow the progression of early kidney disease in people with type 1 diabetes.
Allopurinol is a medicine that has been widely used for over 50 years to decrease high uric acid levels in the blood and prevent gout. If the PERL Study can show that allopurinol can also protect kidney function in people with type 1 diabetes, we will have a new, safe and inexpensive tool to prevent or delay kidney failure that can be used at the earliest stages of renal injury. This would be a major advance for the many people with diabetes who are at risk for kidney problems.
To learn more about PERL, click on the tabs above.