title: New and old agents in the management of diabetic nephropathy.
abstract: OBJECTIVE
  Diabetic nephropathy is a long-standing complication of diabetes mellitus and is responsible for more than 40% of end-stage renal disease cases in developed countries. Unfortunately, conventional renin-angiotensin-aldosterone system (RAAS) inhibitor medications only partially protect against the development and progression of diabetic nephropathy. Moreover, RAAS inhibitors have failed as primary prevention therapy in type 1 diabetes. Thus, agents targeting alternative pathogenic mechanisms leading to diabetic nephropathy have been intensively investigated, which is the topic of this review.
  
  
  RESULTS
  Promising emerging agents have targeted neurohormonal activation (alternative components of the RAAS and neprilysin inhibition), tubuloglomerular feedback mechanisms (sodium glucose cotransporter 2 inhibition and incretin-based therapy) and renal inflammation/fibrosis.
  
  
  CONCLUSIONS
  Evidence demonstrating the potential of these agents to protect and prevent progression of diabetic nephropathy is summarized in this review. There are dedicated clinical trials ongoing with these therapies, which have the potential to change the clinical practice.
authors.affiliation: aDivision of Nephrology, Department of Medicine, University Health Network bDepartment of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada cDepartment of Pediatric Endocrinology, University of Colorado School of Medicine dBarbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA *Drs Lytvyn, Bjornstad and Pun are the co-first authors of the article.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Lytvyn
authors.forename: Petter
authors.initials: P
authors.lastname: Bjornstad
authors.forename: Nicole
authors.initials: N
authors.lastname: Pun
authors.forename: David Z I
authors.initials: DZ
authors.lastname: Cherney
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents