New pharmacological treatments for improving renal outcomes in diabetes.
Diabetic nephropathy is the most common and most rapidly growing cause of end-stage renal failure in developed countries. Diabetic nephropathy results from complex interactions between genetic, metabolic and hemodynamic factors. Improvements in our understanding of the pathogenesis of fibrosis associated with diabetic kidney disease have led to the identification of several novel targets for the treatment of diabetic nephropathy. Albuminuria is a useful clinical marker of diabetic nephropathy, as it can be used to predict a decline in renal function. A reduction in albuminuria might not, however, be reflective of a protective effect of therapies focused on ameliorating renal fibrosis. Although new strategies for slowing down the progression of several types of renal disease have emerged, the challenge of arresting the relentless progression of diabetic nephropathy remains. In this Review, we discuss novel pharmacological approaches that aim to improve the renal outcomes of diabetic nephropathy, including the use of direct renin inhibitors and statins. We also discuss the promise of using antifibrotic agents to treat diabetic nephropathy. The need for novel biomarkers of diabetic nephropathy is also highlighted.
Declèves
Anne-Emilie
AE
University of California San Diego, La Jolla, CA 92093-0711, USA.
Sharma
Kumar
K
D000419:Albuminuria / Q000188:drug therapy; D000577:Amides / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002986:Clinical Trials as Topic; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D018450:Disease Progression; D005650:Fumarates / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D011493:Protein Kinase C / Q000037:antagonists & inhibitors; D011728:Pyridones / Q000627:therapeutic use; D016212:Transforming Growth Factor beta / Q000187:drug effects; D000092502:Renin Inhibitors
D000577:Amides; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D015415:Biomarkers; D005650:Fumarates; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011493:Protein Kinase C; D011728:Pyridones; D016212:Transforming Growth Factor beta; D000092502:Renin Inhibitors; C446481:aliskiren; C093844:pirfenidone