DIABESITY, an ERA-EDTA Working Group focusing on the Nephrological Impact in relation to DIABETES and OBESITY
DIABESITY consists in a Working Group of European investigators aiming at creating and disseminating knowledge on the nephrological impact of Diabetes and Obesity. European research in this field is already of very high quality. However, the magnitude of the problem requires strong and multinational collaborations between teams specialized in different aspects of diabetes and obesity (basic and clinical). This can help the interchange of knowledge and skills between established scientists in the field. By combining various local expertises, EU collaboration could additionally benefit translational and cross-functional research on renal consequences of Diabesity. Finally, this collaborative effort should transfer to a better communication between research, patients and society.
Being a ordinary member of the DIABESITY y Working Group means being part of a network which facilitates exchanges of ideas on basic science research and new treatment protocols.
Becoming an ordinary member of the DIABESITY Working Group is FREE OF CHARGE (ERA-EDTA Membership is not mandatory) and is also open to non-nephrologists.
By joining the DIABESITY Working Group you will receive constant updates on the Working Group initiatives be included in the Directory of DIABESITY Working Groups’ ordinary members and start networking with colleagues from all over the world.
de Vries APJ, Ruggenenti P, Ruan XZ, Praga M, Cruzado JM, Bajema IM, D’Agati VD, Lamb HJ, Pongrac Barlovic D, Hojs R, Abbate M, Rodriquez R, Mogensen CE, Porrini E; ERA-EDTA Working Group Diabesity. Fatty kidney: emerging role of ectopic lipid in obesity-related renal disease. Lancet Diabetes Endocrinol.
2014;2(5):417-26. “There is enough growing insight that ectopic lipid—the accumulation of lipid in non-adipose tissue—is associated with structural and functional changes of mesangial cells, podocytes, and proximal tubular cells to propose the development of obesity related glomerulopathy as a maladapted response to hyperfiltration and albuminuria. In this Review, we discuss the emerging role of ectopic lipid (the accumulation of lipid in non-adipose tissue) from metabolically unhealthy obesity as a novel pathway of obesity-related renal disease.”
Porrini E, Ruggenenti P, Mogensen C-E, Pongrac Barlovic D, Praga M, Cruzado JM, Hojs R, Abbate M, de Vries APJ, for the ERA-EDTA Working Group Diabesity. A Role for Non-Proteinuric Pathways in loss of Renal Function in patients with Type 2 DIABETES? Lancet Diabetes Endocrinol, 2015, in press. “In this personal view we analyze a novel phenotype of renal function decline in type 2 diabetes. Largely on the basis of data in type 1 diabetes, the natural history of diabetic renal disease has been categorized in a sequence of stages: normoalbuminuria, microalbuminuria and macroalbuminuria. Progressive decline of glomerular filtration rate was thought to parallel the onset of macroalbuminuria (overt nephropathy), whereas glomerular hyperfiltration was considered a hallmark of earlier stages. Recent studies clearly demonstrated that albuminuria is a continuum and that the GFR may start to decline before progression to overt nephropathy. In addition to proteinuria, other risk factors may sustain GFR deterioration including female gender, obesity, dyslipidemia (in particular hypertriglyceridemia), hypertension and glomerular hyperfiltration. This may explain why patients with type 2 diabetes can have renal insufficiency even before the onset of overt nephropathy.”
ENBiBA: European Nephrectomy Bio-Bank
The epidemic of obesity and type 2 diabetes (T2DM) may portend severe consequences in nephrology. Obesity and diabetes represent a continuum of metabolic alterations which can greatly increase the chance of renal disease. Common markers of renal damage in diabetes and obesity include i.e. insulin resistance, hypertension, prediabetic alterations in glucose metabolism, insulin resistance, hyperuricaemia, dyslipidemia and lipotoxicity, chronic sub-clinical inflammation, unhealthy obesity, glomerular hyperfiltration and albuminuria. Renal histological changes associated with obesity (metabolically healthy or unhealthy) and early diabetic nephropathy are mostly unknown. The major limitation for studying early histological changes of obesity and diabetes is that renal biopsies are not performed due to ethical concerns. To solve this limitation, we propose the creation of a bio-bank of unaffected renal tissue of pieces of nephrectomy, to study the following points: (a) the histological pattern of renal damage in the whole spectrum of obesity (not only extreme obesity); (b) histological changes in healthy and unhealthy obesity with the same degree of BMI; (c) similarities in renal histology between early diabetes and metabolically unhealthy obesity; (d) the impact of metabolic factors on obesity-related renal damage; (e) possible pathogenetic pathways i.e. lipotoxicity or sub-clinical inflammation in obesity driven renal disease; (f) the prevalence of markers of chronic disease i.e. glomerulsclerosis, tubular and interstitial fibrosis in patients with obesity and early diabetes. This also will give the possibility of analyzing pathogenetic pathways involved in renal damage associated with these diseases.
Today, 15 centres from 7 countries are participating in the project: Portugal (3), Spain, Spain (8), Italy (1), Slovenia (1), Denmark (1) and Israel (1). More than 500 cases have been included, 100 with type 2 diabetes. We are currently preparing the first manuscript with the analysis of renal histology in patients with diabetes, normoalbuminuria, microalbuminuria or proteinuria and diverse degrees of renal function.