David Z. Levine, MD, FRCP

When kidneys fail, most nephrons are scarred and don't function; the remaining function at a higher efficiency. These surviving tubular structures perform at Olympic levels by a wondrous development of structural changes seen under a microscope as well as functional changes. There are wider, bigger tubules with more intricate transporting surfaces so that a larger amount of filtered water, sodium chloride, and bicarbonate can be re-absorbed. Our research work addresses the most common condition that leads to dialysis life support: diabetic kidney disease. In rats, with and without diabetes, we have already studied the ability of surviving tubules first to filter at higher levels than normal, and to briskly reabsorb what is filtered fluid, sodium, chloride and bicarbonate all necessary to sustain life. We will now commence studies of longer term diabetic renal failure when there is deterioration of both kidney filtration and tubular function. In other words, we want to know when and why surviving tubules lose their Olympic abilities to sustain life. We will also investigate how drugs, already used to prevent kidney failure, may influence these surviving tubules and help patients live longer without dialysis life support.