title: Therapeutic modalities in diabetic nephropathy: standard and emerging approaches.
abstract: Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are urgently needed. This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner.
authors: Department of Medicine, Division of Nephrology, University of Virginia, Charlottesville, VA, USA.
authors: Emaad M
authors: EM
authors: Abdel-Rahman
authors: Lawand
authors: L
authors: Saadulla
authors: W Brian
authors: WB
authors: Reeves
authors: Alaa S
authors: AS
authors: Awad
mesh_terms: D000419:Albuminuria / Q000517:prevention & control; D015415:Biomarkers; D001794:Blood Pressure; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D006973:Hypertension / Q000517:prevention & control*; D011320:Primary Health Care; D011507:Proteinuria / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D015415:Biomarkers