DIABETIC NEPHROPATHY: PHARMACOLOGICAL AND EMERGING APPROACH

• Author Information

  Himanshu Peshwani, Surbhi Jangir

• Himanshu Peshwani, Surbhi Jangir
• DIABETIC NEPHROPATHY: PHARMACOLOGICAL AND EMERGING APPROACH

Abstract

Diabetic nephropathy (DN) is a significant microvascular complication of diabetes mellitus, affecting 30-40% of diabetic patients and serving as the leading cause of end-stage renal disease (ESRD) worldwide. DN is characterized by progressive kidney damage due to chronic hyperglycemia, oxidative stress, and hemodynamic abnormalities, resulting in glomerular hypertrophy, mesangial expansion, podocyte loss, and tubulointerstitial fibrosis. The pathogenesis of DN involves the activation of multiple pathways, including the polyol pathway, advanced glycation end-products (AGEs) formation, protein kinase C (PKC) activation, and renin- angiotensin-aldosterone system (RAAS) overactivity. These mechanisms collectively promote inflammation, oxidative stress, and fibrosis, leading to impaired kidney function and proteinuria. While conventional treatments such as RAAS blockade and glycemic control remain essential, emerging therapies offer new hope for better management. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists have shown promising reno-protective effects. Novel therapies, including endothelin receptor antagonists, Bardoxolone methyl, gene therapy, and stem cell-based interventions, target key molecular pathways to halt or reverse disease progression. This review highlights the pathophysiology, current pharmacological treatments, and emerging approaches, emphasizing the importance of early diagnosis and novel interventions in improving renal outcomes for diabetic patients. Key words: Diabetic nephropathy, diabetes mellitus, RAAS, SGLT-2 inhibitors, etc.