Investigational drugs for diabetic nephropathy.
BACKGROUND
Diabetic nephropathy is one of the main causes of end-stage renal disease (ESRD) and is associated with elevated cardiovascular morbidity and mortality.


OBJECTIVE
Current renoprotective treatments for diabetic nephropathy include strict glycemic and optimal blood pressure control, proteinuria/albuminuria reduction and the use of renin-angiotensin-aldosterone system (RAAS) blocking agents. However, the renoprotection provided by these treatments is only partial, calling for more effective approaches.


METHODS
This review examines emerging strategies for the treatment of diabetic nephropathy, including aggressive RAAS blockade, statins, glitazones, ruboxistaurin, and other promising agents.


CONCLUSIONS
In diabetic patients with overt nephropathy, multipharmacological interventions represent a promising way to prevent progression to ESRD. Results of ongoing trials are needed to establish whether the current standard of care of diabetic nephropathy might be improved with these new strategies.
Cortinovis
Monica
M
Mario Negri Institute for Pharmacological Research, Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Via Gavazzeni 11, 24125 Bergamo, Italy. gremuzzi@marionegri.it
Cattaneo
Dario
D
Perico
Norberto
N
Remuzzi
Giuseppe
G
D000449:Aldehyde Reductase / Q000037:antagonists & inhibitors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000517:prevention & control; D015507:Drugs, Investigational / Q000627:therapeutic use*; D050171:Dyslipidemias / Q000188:drug therapy; D065128:Endothelin Receptor Antagonists; D006025:Glycosaminoglycans / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists; D011493:Protein Kinase C / Q000037:antagonists & inhibitors; D000092502:Renin Inhibitors
D000449:Aldehyde Reductase; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000911:Antibodies, Monoclonal; D015507:Drugs, Investigational; D065128:Endothelin Receptor Antagonists; D006025:Glycosaminoglycans; D007004:Hypoglycemic Agents; D000451:Mineralocorticoid Receptor Antagonists; D011493:Protein Kinase C; D000092502:Renin Inhibitors; C007858:glucuronyl glucosamine glycan sulfate