Diabetic nephropathy (DN) is not only the most common cause of end-stage renal disease world-wide but also increases the risk of mortality up to fourteen times compared to normoalbuminuric diabetic patients. After a long time of inertia, recent advances in the management of diabetes have added a valuable share to the effort of prevention and slowing the progression of DN. Beyond their hypoglycemic effects, dipeptidyl peptidase-4 inhibitors, and sodium glucose transporter 2 inhibitors have shown unique renoprotective mechanisms in both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Advances in this field included, in addition, the introduction of many anti-oxidant and anti-inflammatory agents that proved in experimental and in vitro studies to add significant impact on development and progression of DN. Most of these agents are still waiting for clinical studies to confirm their safety and efficacy. Beside their role in improving plans of management, the new discoveries have improved our understanding of the pathogenesis of DN. This review will cover the updates in established and potential therapeutic modalities that would improve the management of DN after discussing the pathogenic pathways that help in understanding the mechanism of action of these different treatments.
Usama Abdel Azim Sharaf El Din, Mona Mansour Salem and Dina Ossama Abdulazim
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