Pathogenesis of diabetic kidney disease

Abstract Diabetic kidney disease (DKD) is characterized by an accumulation of extracellular matrix proteins such as collagen and fibronectin in the kidney, resulting in tubulointerstitial fibrosis, glomerular mesangial hypertrophy and expansion, thickening of the glomerular basement membrane, podocyte foot process effacement, and inflammation due to the infiltration of monocytes and macrophages. All of these factors contribute to kidney function loss and can ultimately lead to progressive chronic kidney disease and kidney failure. In the review, we summarize the current state of knowledge in the pathogenesis of diabetic kidney disease to include the impact of genetic and environmental factors, hemodynamic changes, glycemic control, inflammation, proteinuria and novel mechanisms such as non-coding RNAs and lipotoxicity.