Molecular Mechanisms of Diabetic Nephropathy, General Preventive Measures and Novel Therapeutic Strategies

Diabetic nephropathy (DN) is a major micro-vascular complication in diabetes mellitus (DM). One third of type 1 DM and 1/6th of type 2 DM develop DN account for more than 30 % of total end stage renal disorders (ESRD), the main cause of renal replacement therapy. It is characterized by mesangial expansion, glomerulosclerosis and increased intracellular matrix accumulation. Injury of podocytes and reduced cellular density are considered to be root of the disease. Molecular mechanisms that leads diabetic patients toward nephropathy is hyperglycemia induced production of reactive oxygen species (ROS), advanced glycation end products (AGEs), activation of polyol pathway, increased expression of TGF-, angiotensin II and aldosterone induced oxidative injury. DN can be prevented by controlling the glycemic levels, blood pressure, body weight and consumption of low protein diets along with high potassium supplementation. Therapeutic strategies including intensive glycemic control, blockage of the renin-angiotensin system and anti-hypertensive therapies are proved to be beneficial but still failed to gain complete response. Limited researches are focused toward invent and formulate novel therapeutic agents that would be able to target at a molecular level so as to be more beneficial even if the glycemic level is not well controlled. Therapeutic strategies may include AGEs inhibitors, blockers of receptors for advanced glycation end products, PKC targeted agents, tyrosine kinase inhibitors and mitochondria targeted anti-oxidants.