Renal Research Group, Kolling Institute of Medical Research, Department of Medicine, The University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
Clin Sci (Lond). 2013 Jan;124(1):17-26. doi: 10.1042/CS20120167.
Although there have been major advances in the understanding of the molecular mechanisms that contribute to the development of diabetic nephropathy, current best practice still leaves a significant treatment gap. The incidence of diabetes and associated nephropathy is increasing, with the main cause of mortality being related to cardiovascular causes. Novel therapies which are both 'cardio-renal'-protective seem the logical way forward. In the present review, we discuss the GLP-1 (glucagon-like peptide-1) receptor agonists and DPP-4 (dipeptidyl peptidase-4) inhibitors (incretin-based therapies), which are novel antidiabetic agents used in clinical practice and their role in diabetic nephropathy with specific focus on renoprotection and surrogate markers of cardiovascular disease. We discuss the pleiotropic effects of the incretin-based therapies apart from glucose-lowering and highlight the non-GLP-1 effects of DPP (dipeptidyl peptidase) inhibition. Large-scale clinical studies with cardiovascular end points are underway; however, studies with renal end points are lacking but much needed.
尽管人们对导致糖尿病肾病发展的分子机制有了重大的认识进展，但目前的最佳实践仍存在显著的治疗空白。糖尿病及其相关肾病的发病率正在上升，主要死亡原因与心血管原因有关。具有“心肾保护”作用的新型疗法似乎是合理的前进方向。在本综述中，我们讨论了 GLP-1（胰高血糖素样肽-1）受体激动剂和 DPP-4（二肽基肽酶-4）抑制剂（基于肠促胰岛素的疗法），它们是临床实践中使用的新型抗糖尿病药物，及其在糖尿病肾病中的作用，特别关注肾脏保护和心血管疾病的替代标志物。我们讨论了除降低血糖以外肠促胰岛素疗法的多效性，并强调了 DPP（二肽基肽酶）抑制的非 GLP-1 作用。具有心血管终点的大规模临床研究正在进行中；然而，缺乏但非常需要具有肾脏终点的研究。
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