Diabetic nephropathy

Diabetes is the most common cause of end-stage kidney disease in the world. Diabetic nephropathy is due to cellular and subcellular mechanisms and involves induction of signaling pathways in the kidney which perpetuate the destruction of glomeruli, the intrarenal vasculature, and the interstitium. Diagnosis and prevention center on the detection of albuminuria, tight plasma glucose control, as well as primary interruption of the renin-angiotensin- aldosterone system, which reduces the transglomerular hydrostatic pressure. Some of the newer glucose control therapeutic agents have shown benefit in diabetic nephropathy, and the future holds promise for specific inhibitors of inflammation, as well as inhibitors of microRNA species. Comorbid conditions such as large vessel disease are also commonly associated and require vigilance on the part of the physician and those supervising the predialysis and dialysis patients.