Diabetic Nephropathy: Pathogenesis, Prevention and Treatment

Diabetic Nephropathy (DN) is referred to as the kidney damage that occurs in people with diabetes, the earliest detectable change of which is the thickening in the glomerulus. DN is categorized into two stages; microalbuminuria and macroalbuminuria, in which the kidney leaks more serum albumin than normal in the urine. Increasing numbers of glomeruli are noted to be destroyed by progressive nodular glomerulosclerosis as DN progresses. Numerous signaling mechanisms like advanced glycation end products, enhanced reactive oxygen species generation and activation of protein kinase C have been noted to be involved in the pathogenesis of DN. Moreover, the risk factors identified in the development of DN include hypertension, hyperglycemia, hyperfiltration, smoking, advanced age and high-protein diet. Therapeutic options such as glycemic control, treatment of hypertension, hyperlipidemia are effective for preventing DN, but the numbers of diabetic patients on end-stage renal disease are still increasing and hence, therapeutic strategies preventing the pathogenesis of DN should be developed. In this paper, we review about various signaling mechanisms involved in the pathogenesis of DR. Moreover, various therapies to treat DN have been discussed in the review.