Patients with diabetes mellitus, are prone to develop diabetic kidney disease. A condition that if it is not treated properly, it can evolve to chronic kidney disease. This reduces their life span, since kidney malfunction is harder to treat than the common symptoms or effects of diabetes.
Endocrine hormones that are highly involve in the endocrine reaction in the human body, have been the most common biomarkers to identify kidney disease. Arginine vasopressin (AVP) and its surrogate, copeptin, have been implicated in diabetic kidney disease (DKD) pathogenesis, which develops in a subset of people with longstanding type 1 diabetes (Refardt et. al. 2019). Vasopressin is elevated in obesity & metabolic syndrome as well as cardiovascular and kidney disease (Jalleh 2021). However, the exact mechanism is unknown, but may relate to neurohormonal activation in obesity and insulin resistance. Measuring vasopressin is associated with technical difficulties, due to its relatively small size and short half-life (Asfar 2017). Therefore, Copeptin is a more stable peptide derived from the same precursor molecule as vasopressin and is recognized as a surrogate marker for vasopressin useful in the assessment of fluid and osmosis status in various diseases (Asfar 2017). Vasopressin has been implicated in regulating kidney oxygenation in animal models through its action on sodium transporters in the kidney as well as activating the renin-angiotensin-aldosterone system (as shown in the figure to the right). There are no data on the effects of vasopressin on kidney oxygen availability in adolescents with and without obesity.
Therefore, more studies should be performed by measuring copeptin, which can lead or diagnose early DKD and/or CKD (Chronic kidney disease). This would allow doctors, researchers, and even the patients to have a better understanding of kidney diseases and how to prevent them. Allowing, a lower rate of kidney failure during the early adult stages. Unfortunately, the scientist's community is still working on ensuring a safe and harmless way to perform these studies in patients. This ensures the safety of patients, and allows for better results due to an increase in people willing to participate in such studies.
References:
Afsar B. (2017). Pathophysiology of copeptin in kidney disease and hypertension. Clinical hypertension, 23, 13. https://doi-org.dml.regis.edu/10.1186/s40885-017-0068-y
Jalleh, R., & Torpy, D. J. (2021). The Emerging Role of Copeptin. The Clinical biochemist. Reviews, 42(1), 17–25. https://doi-org.dml.regis.edu/10.33176/AACB-20-00001
Refardt, J., Winzeler, B., & Christ-Crain, M. (2019). Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clinical endocrinology, 91(1), 22–32. https://doi-org.dml.regis.edu/10.1111/cen.13991
This was a really cool post to read, Diego! I have a friend who suffers from diabetes, so it's really nice to learn more about how insulin and diseases related to it work. I can see that there's still a lot that needs to be done in order to take a more preventative measure to DKD rather than take a reactive stance. It reminds me of why vaccines are so important as a preventative measure to disease.
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