Diabetic nephropathy is the leading cause of end-stage renal disease in the United States. The progression of
kidney disease in patients with diabetes can take many years, and interventions such as glycemic control, blood pressure
control, and inhibition of the renin-angiotensin-aldosterone system have been shown to slow this progression. Despite the
implementation of these strategies, the number of patients with diabetes that ultimately develop end-stage renal disease
remains high. Recent investigation has focused on the optimization of renin-angiotensin-aldosterone system blockade in
patients with diabetic nephropathy using combinations of drugs that target this pathway. Additional investigation has focused
on the potential of novel therapies that either target various pathways upregulated by hyperglycemia or other targets
believed to promote progression of diabetic nephropathy such as the endothelin system, inflammation and vitamin D receptors.
This review article addresses some of the well-established principles regarding the progression and accepted
management of diabetic nephropathy and includes current updates on the most recent clinical research trials exploring
novel therapeutics in this field.
Keywords: Diabetes, Diabetic Nephropathy, Renin-Angiotensin-Aldosterone System, Hypertension, Endothelin-1, Albuminuria
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