Comprehensive approach to diabetic nephropathy

Abstract

Diabetic nephropathy (DN) is a leading cause of mortality and morbidity in patients with diabetes. This complication reflects a complex pathophysiology, whereby various genetic and environmental factors determine susceptibility and progression to end-stage renal disease. DN should be considered in patients with type 1 diabetes for at least 10 years who have microalbuminuria and diabetic retinopathy, as well as in patients with type 1 or type 2 diabetes with macroalbuminuria in whom other causes for proteinuria are absent. DN may also present as a falling estimated glomerular filtration rate with albuminuria as a minor presenting feature, especially in patients taking renin–angiotensin–aldosterone system inhibitors (RAASi). The pathological characteristic features of disease are three major lesions: diffuse mesangial expansion, diffuse thickened glomerular basement membrane, and hyalinosis of arterioles. Functionally, however, the pathophysiology is reflected in dysfunction of the mesangium, the glomerular capillary wall, the tubulointerstitium, and the vasculature. For all diabetic patients, a comprehensive approach to management including glycemic and hypertensive control with RAASi combined with lipid control, dietary salt restriction, lowering of protein intake, increased physical activity, weight reduction, and smoking cessation can reduce the rate of progression of nephropathy and minimize the risk for cardiovascular events. This review focuses on the latest published data dealing with the mechanisms, diagnosis, and current treatment of DN.

Effect of Sodium-Glucose Co-Transporter 2 Inhibitor, Dapagliflozin, on Renal Renin-Angiotensin System in an Animal Model of Type 2 Diabetes

“…The prevalence of renal complications in patients with type 2 diabetes reaches about 40% with significant progression to ESRD [1–3]. Treatment options have increased substantially over the last decade, but have not yet translated into a remarkable reduction in the incidence of ESRD related to diabetic nephropathy [4].…”

Metformin with insulin relieves oxidative stress and confers renoprotection in type 1 diabetes in vivo

“…Type 1 diabetes (T1D) is caused by destruction of pancreatic β-cells and is routinely treated by the exogenous subcutaneous insulin injections in order to maintain normoglycemia and mitigate the development of diabetes complications (1)(2)(3). Endpoint micro-and macro-vascular complications such as nephropathy, retinopathy and cardiovascular disease are associated with increased morbidity and mortality in diabetic patients.…”

Chronic Administration of Visfatin Ameliorated Diabetic Nephropathy in Type 2 Diabetic Mice

“…The kidney has been a main target organ of complications in the metabolic syndrome of obesity and diabetes mellitus [1][2][3]. Although the kidney can be damaged by hyperglycemia in diabetes mellitus, its role has not been detailed in glucose metabolism and insulin resistance.…”