title: Diabetic nephropathy: What does the future hold?
abstract: The consensus management of diabetic nephropathy (DN) in 2015 involves good control of glycaemia, dyslipidaemia and blood pressure (BP). Blockade of the renin-angiotensin-aldosterone system using angiotensin-converting enzyme inhibitors, angiotensin-2 receptor blockers or mineralocorticoid inhibitors are key therapeutic approaches, shown to be beneficial once overt nephropathy is manifest, as either, or both, of albuminuria and loss of glomerular filtration rate. Some significant additional clinical benefits in slowing the progression of DN was reported from the Remission clinic experience, where simultaneous intensive control of BP, tight glycaemic control, weight loss, exercise and smoking cessation were prioritised in the management of DN. This has not proved possible to translate to more conventional clinical settings. This review briefly looks over the history and limitations of current therapy from landmark papers and expert reviews, and following an extensive PubMed search identifies the most promising clinical biomarkers (both established and proposed). Many challenges need to be addressed urgently as in order to obtain novel therapies in the clinic; we also need to examine what we mean by remission, stability and progression of DN in the modern era.
authors.affiliation: Renal, Dialysis and Transplantation Unit, Guy's and St Thomas' Hospital, London, UK. rosa_montero@hotmail.com.
authors.forename: R M
authors.initials: RM
authors.lastname: Montero
authors.affiliation: Hospital "C.I.Parhon" and University of Medicine "Grigore T Popa", Iasi, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Covic
authors.affiliation: Cardiovascular Division, Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospital, School of Medicine and Life Science, King's College London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Gnudi
authors.affiliation: Renal, Dialysis and Transplantation Unit, Guy's and St Thomas' Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Goldsmith
mesh_terms: D003131:Combined Modality Therapy; D003928:Diabetic Nephropathies / Q000628:therapy*; D018450:Disease Progression; D005544:Forecasting; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
keywords: Albuminuria; Anti-fibrotics; Diabetic nephropathy; Inflammation; New therapies; RAAS blockade