Diabetic nephropathy: Time to withhold development and progression - A review
Usama A A Sharaf El Din1, Mona M Salem2, Dina O Abdulazim3
1Nephrology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt.
Abstract:
The recent discoveries in the fields of pathogenesis and management of diabetic nephropathy have revolutionized the knowledge about this disease. Little was added to the management of diabetic nephropathy after the introduction of renin angiotensin system blockers. The ineffective role of the renin- angiotensin system blockers in primary prevention of diabetic nephropathy in type 1 diabetes mellitus necessitated the search for other early therapeutic interventions that target alternative pathogenic mechanisms. Among the different classes of oral hypoglycemic agents, recent studies highlighted the distinguished mechanisms of sodium glucose transporter 2 blockers and dipeptidyl peptidase-4 inhibitors that settle their renoprotective actions beyond the hypoglycemic effects. The introduction of antioxidant and anti-inflammatory agents to this field had also added wealth of knowledge. However, many of these agents are still waiting well-designed clinical studies in order to prove their beneficial therapeutic role. The aim of this review of literature is to highlight the recent advances in understanding the pathogenesis, diagnosis, the established and the potential renoprotective therapeutic agents that would prevent the development or the progression of diabetic nephropathy.
Insights
Recent discoveries offer new hope for diabetic nephropathy management beyond traditional blockers. Novel therapies targeting alternative pathways show promise in preventing kidney disease progression.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Diabetic nephropathy knowledge has advanced, but management options beyond renin-angiotensin system blockers are limited.
- Renin-angiotensin system blockers show limited efficacy in primary prevention of diabetic nephropathy in type 1 diabetes mellitus.
- There is a need for early therapeutic interventions targeting alternative pathogenic mechanisms.
Purpose of the Study:
- To review recent advances in understanding diabetic nephropathy pathogenesis and diagnosis.
- To highlight established and potential renoprotective therapeutic agents.
- To discuss novel agents that may prevent diabetic nephropathy development or progression.
Main Methods:
- Literature review of recent discoveries in diabetic nephropathy.
- Analysis of established and emerging therapeutic interventions.
- Evaluation of agents targeting alternative pathogenic mechanisms.
Main Results:
- Sodium glucose transporter 2 blockers and dipeptidyl peptidase-4 inhibitors offer renoprotective effects beyond glucose lowering.
- Antioxidant and anti-inflammatory agents are emerging as potential therapeutic options.
- Further clinical studies are needed to validate the role of many novel agents.
Conclusions:
- New therapeutic strategies beyond renin-angiotensin system blockers are crucial for diabetic nephropathy management.
- Targeting alternative pathogenic pathways with agents like SGLT2 inhibitors and DPP-4 inhibitors shows promise.
- Continued research and clinical trials are essential to establish the efficacy of emerging renoprotective therapies.
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