Updates in the management of diabetic nephropathy

Diabetic nephropathy is the most frequent cause of end stage renal disease (ESRD) worldwide. Current treatments consisting of glycaemic and blood pressure control, and efficient anti-proteinuric effects of RAS blockade are not sufficient to prevent progression of ESRD in a substantial proportion of patients. This finding is consistent with the hypothesis that key pathogenic mechanisms leading to progression of renal disease in diabetic patients are not modified or inactivated by current therapeutic approaches. Despite extensive research in molecular signalling mechanism and a number of high-profile clinical trials of potentially nephroprotective agents, the pathogenetic mechanisms underlying the diabetic nephropathy are not fully understood. Currently, only one trial (atrasentan) that seems to have a potentially renoprotective effect is underway. Further research into the potential nephroprotective effects of novel glucose lowering agents is needed.