Renal function and pancreas transplantation

A crucial question to be addressed in patients receiving pancreas transplantation subsumes the capacity to arrest or reverse the progression of diabetic nephropathy in the recipient. This issue can be addressed by functional or morphologic studies of the patient's own kidney. While the morphologic studies permit evaluation of renal lesions irrespective of transplanted vs intact kidneys, they necessitate the procurement of a series of biopsies. The functional studies, on the other hand, can theoretically be obtained at any time in the patient (at least from those with their own kidneys) by simple collection of urine for measurements of glomerular filtration rate and urinary protein excretion. In general, both functional and morphologic procedures have been important factors in understanding the progression of diabetic nephropathy, especially in animals. Their efficacy in addressing the success of human pancreas transplantation must now be determined.