Journal Article

Diabetic Nephropathy: a Tangled Web to Unweave

Magee, Corey, Grieve, David J., Brazil, Derek P., Watson, Chris J.

2017

Overview

Diabetic nephropathy (DN) is currently the leading cause of end-stage renal disease globally. Given the increasing incidence of diabetes, many experts hold the view that DN will eventually progress toward pandemic proportions. Whilst hyperglycaemia-induced vascular dysfunction is the primary initiating mechanism in DN, its progression is also driven by a heterogeneous set of pathological mechanisms, including oxidative stress, inflammation and fibrosis. Current treatment strategies for DN are targeted against the fundamental dysregulation of glycaemia and hypertension. Unfortunately, these standards of care can delay but do not prevent disease progression or the significant emotional, physical and financial costs associated with this disease. As such, there is a pressing need to develop novel therapeutics that are both effective and safe. Set against the genomic era, numerous potential target pathways in DN have been identified. However, the clinical translation of basic DN research has been met with a number of challenges. Moreover, the notion of DN as a purely vascular disease is outdated and it has become clear that DN is a multi-dimensional, multi-cellular condition. The review will highlight the current therapeutic approaches for DN and provide an insight into how the inherent complexity of DN is shaping the research pathways toward the development and clinical translation of novel therapeutic strategies.

• Publisher: Springer US,Springer Nature B.V
• Subject: Antihypertensive Agents - administration & dosage / Antihypertensive Agents - therapeutic use / Blood glucose / Cardiology / Diabetes / Diabetes mellitus / Diabetic Nephropathies - drug therapy / Diabetic Nephropathies - etiology / Diabetic Nephropathies - metabolism / Diabetic Nephropathies - pathology / Diabetic nephropathy / End-stage renal disease / Fibrosis / Humans / Hyperglycemia / Hypertension / Hypoglycemic Agents - administration & dosage / Hypoglycemic Agents - therapeutic use / Kidney diseases / Kidney Failure, Chronic - prevention & control / Kidney transplantation / Medicine / Medicine & Public Health / Nephropathy / Oxidative stress / Oxidative Stress - drug effects / Pandemics / Renal Circulation - drug effects / Renin-Angiotensin System - drug effects / Review / Review Article / Translation / Vascular diseases