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  • Review Article
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Diabetic nephropathy: diagnosis and treatment

Nature Reviews Endocrinology volume 9, pages 713–723 (2013)Cite this article

Subjects

Key Points

  • Diabetes mellitus remains the major cause of end-stage renal disease in the Western world

  • Increasingly, individuals with diabetes mellitus have reduced glomerular filtration rate in the absence of albuminuria; this heterogenous group includes some individuals with classic morphological changes of diabetic nephropathy on renal biopsy

  • Clinical research activity is increasing to identify new biomarkers to predict and monitor diabetic nephropathy

  • Studies focusing on drugs that inhibit the renin–angiotensin system suggest that early administration of such agents in normalbuminuric individuals is not particularly effective at preventing the development of diabetic nephropathy

  • Whether the newer glucose lowering agents, such as glucagon-like peptide 1 analogues and dipeptidyl peptidase-4 inhibitors, will confer renoprotection, independent of their hypoglycaemic effect remains to be determined

Abstract

Nephropathy remains a major cause of morbidity and a key determinant of mortality in patients with type 1 or type 2 diabetes mellitus. Research is ongoing to identify biomarkers that in addition to albuminuria and glomerular filtration rate assist in the prediction and monitoring of renal disease in diabetes mellitus. Current strategies to treat this condition focus on intensification of glycaemic control and excellent control of blood pressure using regimens based on blockade of the renin–angiotensin system. Other approaches to control blood pressure and afford renoprotection are under active clinical investigation, including renal denervation and endothelin receptor antagonism. With increasing understanding of the underlying pathophysiological processes implicated in diabetic nephropathy, new specific renoprotective treatment strategies are anticipated to become available over the next few years.

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Figure 1: Putative pathways implicated in the pathogenesis of diabetic nephropathy, including established and potential new treatment strategies.

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Authors and Affiliations

  1. Diabetes Division, Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, 3004, Vic, Australia

    Daniel Fineberg, Karin A. M. Jandeleit-Dahm & Mark E. Cooper

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  1. Daniel Fineberg
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D. Fineberg researched data for the article, contributed to discussion of the content, wrote the article and reviewed and edited the manuscript before submission. K. A. M. Jandeleit-Dahm researched data for the article, contributed to discussion of the content and reviewed and edited the manuscript before submission. M. E. Cooper contributed to discussion of the content, wrote the article and reviewed and edited the manuscript before submission.

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Correspondence to Daniel Fineberg.

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Competing interests

M. E. Cooper declares associations with the following companies: AstraZeneca (advisory board), Boehringer Ingelheim (speakers fees), Lilly (speakers fees), MSD (advisory board), Novo Nordisk (advisory board), Servier (speakers fees), Takeda (advisory board). The other authors declare no competing interests.

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Fineberg, D., Jandeleit-Dahm, K. & Cooper, M. Diabetic nephropathy: diagnosis and treatment. Nat Rev Endocrinol 9, 713–723 (2013). https://doi.org/10.1038/nrendo.2013.184

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