Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

Abstract

Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are urgently needed. This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner.

Corosolic acid inhibits the proliferation of glomerular mesangial cells and protects against diabetic renal damage

“…However, the role of optimizing control to retard, prevent or reverse DN remains controversial5, and the number of patients with DN that ultimately develop ESRD remains unacceptably high4. The treatment of DN is therefore still an unresolved issue posing a formidable challenge36.…”

Stem Cells as a Therapeutic Approach to Chronic Kidney Diseases

“…Diabetes is the most common factor underlying chronic kidney disease, accounting for nearly 50% of new cases [4]. Diabetic nephropathy occurs in both type 1 and type 2 diabetes, and is characterized by initial glomerular hyperfiltration, followed by thickening of the GBM, glomerular hypertrophy, and mesangial expansion, ultimately leading to proteinuria, renal fibrosis, and end-stage renal disease.…”

“…CKD is a serious global health problem with increasing prevalence in association with growing rates of obesity [2,3], diabetes [4], and cardiovascular disease [5]. Currently, dialysis and kidney transplantation remain the only viable treatments despite significant complications associated with both.…”

The renal protective effects of Anoectochilus roxburghii polysaccharose on diabetic mice induced by high-fat diet and streptozotocin

“…It has been reported that about 20-30% patients of diabetes are prone to develop diabetic nephropathy usually 5 or more years after the onset of diabetes mellitus (Abdel-Rahman et al, 2012). Moreover, diabetic nephropathy is the most common single cause of end-stage renal disease (Molitch et al, 2004).…”