Advances in the Pharmacological Management of Diabetic Nephropathy: A 2022 International Update

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. Its pathogenesis encompasses functional alterations involving elevated intraglomerular and systemic pressure, increased activity of the renin-angiotensin system (RAS) and oxidative stress, and the eventual de...

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Published in:Biomedicines 2023-01, Vol.11 (2), p.291
Main Authors: Giglio, Rosaria Vincenza, Patti, Angelo Maria, Rizvi, Ali Abbas, Stoian, Anca Panta, Ciaccio, Marcello, Papanas, Nikolaos, Janez, Andrej, Sonmez, Alper, Banach, Maciej, Sahebkar, Amirhossein, Rizzo, Manfredi
Format: Article
Language:English
Subjects:
Angiotensin
Blood pressure
cardiovascular risk
Creatinine
Diabetes
diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetic nephropathies
Diabetic retinopathy
Disease prevention
Drug therapy
Dyslipidemia
End-stage renal disease
Endocrine system
Fibrosis
Glucagon
Glucagon-like peptide 1
Glucose
Hemodynamics
Hyperglycemia
Hypertension
innovative therapy
Insulin resistance
kidney disease
Kidney diseases
kidney protection
Medical innovations
Nephropathy
Nonsteroidal anti-inflammatory drugs
Oxidative stress
Pathogenesis
Peptides
Reabsorption
Renin
Review
Risk factors
Weight control
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Summary:Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. Its pathogenesis encompasses functional alterations involving elevated intraglomerular and systemic pressure, increased activity of the renin-angiotensin system (RAS) and oxidative stress, and the eventual development of renal fibrosis. The management of DN involves the optimization of blood pressure (BP) and blood glucose targets. However, treatment of these risk factors slows down but does not stop the progression of DN. Innovative pharmacologic therapies for dyslipidemia and type 2 diabetes mellitus (T2DM) could play a key role in bridging this gap and attenuating the residual risk of DN beyond traditional risk factor management. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter-2 inhibitors (SGLT-2is), and inhibitors of mineralocorticoid receptor-mediated sodium reabsorption are recently introduced drug classes that have been shown to have positive effects on kidney function in individuals with T2DM. The aim of this review is to provide an update on the therapeutic options available in order to prevent or slow the onset and progression of DN in diabetic patients.
ISSN:2227-9059
2227-9059
DOI:10.3390/biomedicines11020291