Mechanistic Insight and Management of Diabetic Nephropathy: Recent Progress and Future Perspective

Abstract

Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes and the largest single cause of end-stage renal disease (ESRD) in many developed countries. DN is also associated with an increased cardiovascular mortality. It occurs as a result of interaction between both genetic and environmental factors. Hyperglycemia, hypertension, and genetic predisposition are the major risk factors. However, the exact mechanisms of DN are unclear. Despite the benefits derived from strict control of glucose and blood pressure, as well as inhibition of renin-angiotensin-aldosterone system, many patients continue to enter into ESRD. Thus, there is urgent need for improving mechanistic understanding of DN and then developing new and effective therapeutic approaches to delay the progression of DN. This review focuses on recent progress and future perspective about mechanistic insight and management of DN. Some preclinical relevant studies are highlighted and new perspectives of traditional Chinese medicine (TCM) for delaying DN progression are discussed in detail. These findings strengthen the therapeutic rationale for TCM in the treatment of DN and also provide new insights into the development of novel drugs for the prevention of DN. However, feasibility and safety of these therapeutic approaches and the clinical applicability of TCM in human DN need to be further investigated.

Renoprotection of dapagliflozin in human renal proximal tubular cells via the inhibition of the high mobility group box 1‑receptor for advanced glycation end products‑nuclear factor‑κB signaling pathway

“…Diabetic nephropathy is one of the most serious microvascular complications of diabetes and is the main cause of end-stage renal disease (ESRD). Strict control of glucose and blood pressure may delay the progression of diabetic nephropathy; however, many patients still progress to ESRD (1). The pathophysiological mechanism(s) of diabetic nephropathy is complex and has not been fully elucidated.…”

Diabetic Nephropathy an Obvious Complication in Long Term Type 1 Diabetes Mellitus: A Case Study

“…Elevated endothelin level is a constant feature of diabetic patients. Endothelin-1 (ET-1) is involved in the development of DN [34]. DN is allied with increased countenance of surface DPP-4, predominantly on endothelial and tubular epithelial cells.…”

Effect of microRNA‐141 on the development of diabetic nephropathy through regulating AKT/AMPK signaling pathway by targeting insulin receptor substrate 2

“…Compared with the treatment of anti-miR-Control, knockdown of miR-141 displayed an activation effect on the AKT/AMPK pathway, uncovered by promotion of the expressions of AMPKα, p-AMPKα, Akt, and p-Akt proteins, whereas the regulatory effect of miR-141 inhibition on AKT/AMPK signaling pathway was ablated by interference of IRS2 ( Figure 6). 15 At present, the incidence of diabetes is increasing rapidly worldwide, especially in developing countries. According to incomplete epidemiological statistics, the number of diabetic patients will rise to 366 million by 2030 worldwide, of which DN patients will exceed 100 million.…”