New and old agents in the management of diabetic nephropathy : Current Opinion in Nephrology and Hypertension (original) (raw)
EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri
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.
Correspondence to David Z.I. Cherney, MD, PhD, Toronto General Hospital, 585 University Avenue, 8N-845, Toronto, ON M5G 2N2, Canada. Tel: +1 416 340 4151; fax: +1 416 340 4999; e-mail: [email protected]
Current Opinion in Nephrology and Hypertension 25(3):p 232-239, May 2016. | DOI: 10.1097/MNH.0000000000000214
Abstract
Purpose of review
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.
Recent findings
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.
Summary
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.
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