European Journal of Biomedical and Pharmaceutical Sciences

REVIEW ON RECENT ADVANCES IN THE MANAGEMENT OF DIABETIC NEPHROPATHY

Sriram S*, Suresh Damodharan and Jipin Thomas Jacob

ABSTRACT

Diabetes mellitus and chronic kidney disease have become two of the fastest growing pathologies worldwide while diabetic kidney disease is still the leading cause of CKD and end stage renal disease. Population ageing and increase in prevalence of many interrelated comorbidities suggest that these numbers will worsen in the near future. Diabetic nephropathy is the leading cause of chronic renal disease in patients starting renal replacement therapy. DN has been classically defined asincreased protein excretion in urine. Early stage is characterized by a small increase in urinary albumin excretion, also called microalbuminuria or incipient DN and advanced disease is defined by the presence of macroalbuminuria or proteinuria or overt DN. The two main risk factors for DN are hyperglycemia and arterial hypertension and also because of smoking, dyslipidemia, proteinuria, glomerular hyperfilteration and dietary factors. For the prevention and treatment of DN, it is important to know the stage of DN which is the target of intervention and the outcome of interest and also to know the risk factors. Classical nonspecific measures include glycemic control, blood pressure control, weight loss, protein restriction, and smoking cessation and treatment measures include use of renin-angiotensin aldosterone blockers, vitamin D analogues like paricalcitol, nonspecific phosphodiesterase inhibitors like pentoxyfylline, endothelin receptor antagonists, antifibroticand anti-inflammatory agents et and new methods like use of novel biomarkers, micro RNA and drug discoveries with targets like NOX, PKC-β etc.

Keywords: Diabetic Nephropathy, CKD, Hyperglycemia, Proteinuria.