Role of Inflammation in Progression of Chronic Kidney Disease in Type 2 Diabetes Mellitus: Clinical Implications

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology Pub Date : 2023-05-01 DOI:10.1016/j.semnephrol.2023.151431

Yasuhiro Oda MD, Hiroshi Nishi MD, PhD, Masaomi Nangaku MD, PhD

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引用次数: 0

Abstract

Progression of chronic kidney disease in type 2 diabetes has been understood conventionally as a consequence of intraglomerular hemodynamic changes and aberrant metabolic pathways. However, an increasing body of experimental evidence has highlighted the role of inflammatory response in the progression of diabetic kidney disease. Macrophage polarization in response to specific microenvironmental stimuli affects the pathology of diabetic kidneys. The diabetic milieu also up-regulates inflammatory cytokines, chemokines, and adhesion molecules, and promotes inflammatory signal transduction pathways, including inflammasomes. Therefore, from a reverse translational perspective, modulation of the inflammatory response may be the driving force of the renoprotective effects of renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and mineralocorticoid receptor antagonists, all of which have been shown to slow disease progression. Currently, many agents that target the inflammation in the kidneys directly are evaluated in clinical trials. This article discusses recent clinical and experimental milestones in drug development for diabetic kidney disease with a perspective on inflammation in the kidneys. Such insights may enable a targeted approach to discovering novel drugs against chronic kidney disease in type 2 diabetes.

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炎症在2型糖尿病慢性肾脏疾病进展中的作用：临床意义。

2型糖尿病中慢性肾脏疾病的进展通常被理解为肾小球内血液动力学变化和异常代谢途径的结果。然而，越来越多的实验证据强调了炎症反应在糖尿病肾病进展中的作用。巨噬细胞对特定微环境刺激的极化影响糖尿病肾脏的病理学。糖尿病环境还上调炎症细胞因子、趋化因子和粘附分子，并促进炎症信号转导途径，包括炎症小体。因此，从反翻译的角度来看，炎症反应的调节可能是肾素-血管紧张素系统抑制剂、钠-葡萄糖协同转运蛋白2抑制剂和盐皮质激素受体拮抗剂的肾脏保护作用的驱动力，所有这些都已被证明可以减缓疾病进展。目前，许多直接针对肾脏炎症的药物在临床试验中进行了评估。本文从肾脏炎症的角度讨论了糖尿病肾病药物开发的最新临床和实验里程碑。这些见解可能使我们能够有针对性地发现治疗2型糖尿病慢性肾脏疾病的新药。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in nephrology 医学-泌尿学与肾脏学

CiteScore

5.60

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to the clinical practice of nephrology. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training.