Diabetic Nephropathy- Misreading the Tea Leaves?

One of the most feared complications of diabetes is kidney disease, also called diabetic nephropathy (DN). DN is the leading cause of end-stage renal disease in the U.S., and the incidence of DN is poised to double over the next ten years due to the rapid rise in the number of cases of diabetes, particularly type 2 diabetes. The expected cost of this problem is expected to top $28 billion. Keep in mind that this is not the cost of treating diabetes per se, but only this single complication. This is a BIG issue. Most of what we know about DN comes from observations made in patients with type 1 diabetes, and we have tended to extrapolate what we have learned from that condition to type 2 diabetes. As we will see, this may not have been a completely valid approach. At any rate, the course of DN is believed to begin with the spillage of small amounts of a blood protein called albumin into the urine. The kidney contains millions of structures called glomeruli; you can think of each glomerulus as a filter, similar to the fuel or air filters in your car. Water, salt, and other small molecules can pass freely into the urine, but larger things