Diabetic Kidney Disease: State of the Art |Biomedgrid

Diabetic kidney disease is one of the microvascular complications with the greatest impact on morbidity and mortality in patients with diabetes. Previously thought to be a linear series of events consisting of ultrafiltration, glomerular hypertension, albuminuria and successive decreases in GFR, it is now known to be affected by multiple metabolic and hemodynamic pathophysiological mechanisms, leading to cell signaling pathways, oxidative stress, deregulated autophagy, triggering structural damage and functional alterations that lead to disease. Risk factors for the disease that trigger pathophysiological mechanisms that contribute to its development are also recognized, such as obesity, smoking, poor metabolic control, arterial hypertension, ethnicity, among others. Although current therapies have not completely stopped the development of the disease, current efforts are focused on developing new therapies that can positively influence its onset and progression, with both SGLTi and AR-GLP1 showing a leading role, improving cardiovascular and cardiovascular outcomes. kidneys, regardless of their effect on the control of hyperglycemia, which is why they currently constitute a fundamental pillar of management. Finer none, a mineralocorticoid receptor antagonist, is another current therapy that has been shown to have an impact on cardiovascular and renal outcomes, playing a complementary role to ACE inhibitors and ARBs in the management of albuminuria.