Improvements in the Management of Diabetic Nephropathy

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Abstract
The Review of Diabetic Studies,2015,12,1-2,119-133.
Published:August 2015
Type:Review Article
Authors:
Author(s) affiliations:

Evangelia Dounousi1, Anila Duni1, Konstantinos Leivaditis2, Vasilios Vaios2, Theodoros Eleftheriadis2, and Vassilios Liakopoulos2

1University of Ioannina, School of Health Siences, Department of Internal Medicine, Division of Nephrology, Ioannina, GREECE.

2Division of Nephrology and Hypertension, First Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GREECE. 

Abstract:

The burden of diabetes mellitus is relentlessly increasing. Diabetic nephropathy is the most common cause of endstage renal disease (ESRD) worldwide and a major cause of morbidity and mortality in patients with diabetes. The current standard therapy of diabetic nephropathy involves intensive treatment of hyperglycemia and strict blood pressure control, mainly via blockade of the renin-angiotensin system (RAS). Attention has been drawn to additional beneficial effects of oral hypoglycemic drugs and fibrates on other aspects of diabetic nephropathy. On the other hand, antiproteinuric effects of RAS combination therapy do not seem to enhance the prevention of renal disease progression, and it has been associated with an increased rate of serious adverse events. Novel agents, such as bardoxolone methyl, pentoxifylline, inhibitors of protein kinase C (PKC), sulodexide, pirfenidone, endothelin receptor antagonists, vitamin D supplements, and phosphate binders have been associated with controversial outcomes or significant side effects. Although new insights into the pathogenetic mechanisms have opened new horizons towards novel interventions, there is still a long way to go in the field of DN research. The aim of this review is to highlight the recent progress made in the field of diabetes management based on the existing evidence. The article also discusses novel targets of therapy, with a special focus on the major pathophysiologic mechanisms implicated in the initiation and progression of diabetic nephropathy.