Diabetic kidney disease update: Pathogenesis and treatment overview for clinicians

Diabetes mellitus is a common cause of chronic kidney disease that progresses to end-stage renal disease (ESRD). Albuminuria (proteinuria) is an early manifestation of diabetic kidney disease (DKD). Although the hemodynamic alterations that occur in diabetics seem the underlying mechanism, others such as metabolic, inflammatory, and hypoxia have a role in DKD pathophysiology. Despite the proven beneficial effects of angiotensin-converting enzyme inhibitors and renin–angiotensin II–aldosterone receptor blockades in proteinuria improvement, their effect to prevent the DKD and to modify its progression to ESRD is not clear enough. New agents such as SLGT2 and autophagy inhibitors and anti-inflammatory are promising agents that may improve proteinuria and inhibit DKD progression. Pathophysiology and new strategies in DKD therapy updates will be reviewed.