D Sree Bhushan Raju
Nizam’s Institute of Medical Sciences
India
Title: Diabetic nephropathy- What is new?
Biography
Biography: D Sree Bhushan Raju
Abstract
Diabetic nephropathy (DN) refers to a characteristic set of structural and functional kidney abnormalities in patients withrndiabetes. It is a secondary glomerulopathy. DN is characterized by persistent albuminuria, decline in GFR, raised bloodrnpressure and enhanced cardiovascular mortality. The natural history of DN (typically defined in type1) progresses in 5 stagesrnhyper-filtration, microalbuminuria, macroalbuminuria, decline in GFR and ESRD. Recent studies show that early progressiverndecline in GFR precedes the onset of microalbuminuria and its progression to macroalbuminuria. The terms microalbuminuriarnand macroalbuminuria are replaced by moderately and severely increased albuminuria respectively. The previously unclassifiedrnhistology of DN is now classified into 4 classes by ISNRPS for uniformity in reporting. Interstitial eosinophilic aggregatesrnare assuming importance in DN and are not considered as allergic interstitial nephritis. Treatment of diabetes and DN hadrnundergone several advances. SGLT2 inhibitors, though thought to have lower pharmacodynamic activity in CKD have shownrnimprovements in weight and fewer episodes of hyperkalemia due to osmotic diuresis. Several nephro-protective strategies wererntried in diabetic nephropathy. Nephroprotection by dual RAAS blockade did not prove beneficial. Several molecules tried forrnnephroprotection in DN are Pentoxyphylline, Vitamin d3, Protein kinase Cinhibitors, Endothelin antagonists, Allopurinol,rnAntioxidants, RAGE antagonists, Bardoxolone methyl, Mycophenolate mofetil etc. Caloric restriction is a new anti-agingrnexperimental paradigm. It increases Sirtuins which are thought to have cyto-protective and anti-inflammatory activities inrnthe cell. Drugs targeting the epigenetic changes were also tried in DN. Nephroprotective strategies in DN remains the area ofrnintense research.