VA Medical Center and Georgetown University, Washington, DC, United States.
2nd Prop Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.
Curr Vasc Pharmacol. 2020;18(2):139-147. doi: 10.2174/1570161117666190405164749.
Diabetes mellitus (DM) is one of the most common diseases worldwide. Its adverse effects on several body organs, have made treatment of DM a priority. One of the most serious complications of DM is diabetic nephropathy (DN).
The aim of this review is to critically discuss available data on the pharmacological management of DN.
A comprehensive review of the literature was performed to identify studies assessing the impact of several drug classes on DN.
Several studies have been conducted in order to find a novel and effective treatment of DN. So far, the cornerstone therapy of DN consists of renin-angiotensin system (RAS) inhibitors, agents that decrease the synthesis of intrarenal angiotensin II or block its receptors. Their antiproteinuric and antihypertensive effects can not only decelerate the progress of DN but prevent its onset as well. Novel antidiabetic drugs, such as sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide- 1 receptor agonists (GLP-1 RA), are promising agents in the therapy of DN, due to their positive effect on renal and cardiovascular adverse events. From lipid-lowering agents, atorvastatin improves DN up to stage 3 and substantially reduces CVD.
RAS inhibitors, SGLT-2i and GLP-1 agonists were found to be beneficial for the treatment of DN. Larger renal trials are needed in order to incorporate these drugs into the first line treatment of DN.
糖尿病（DM）是全球最常见的疾病之一。它对多个身体器官的不良影响使得 DM 的治疗成为当务之急。DM 最严重的并发症之一是糖尿病肾病（DN）。
本文旨在批判性地讨论 DN 药物治疗的现有数据。
对评估几种药物类别对 DN 影响的研究进行了全面的文献回顾。
为了寻找治疗 DN 的新方法，已经进行了多项研究。到目前为止，DN 的基础治疗仍然是肾素-血管紧张素系统（RAS）抑制剂，这些药物可以减少肾内血管紧张素 II 的合成或阻断其受体。它们的降蛋白尿和降压作用不仅可以减缓 DN 的进展，还可以预防其发生。新型抗糖尿病药物，如钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）和胰高血糖素样肽-1 受体激动剂（GLP-1 RA），由于对肾脏和心血管不良事件的积极作用，在 DN 的治疗中具有广阔的前景。在降脂药物中，阿托伐他汀可改善 3 期及以上的 DN，并显著降低 CVD。
RAS 抑制剂、SGLT-2i 和 GLP-1 激动剂被发现对 DN 的治疗有益。需要进行更大规模的肾脏试验，以便将这些药物纳入 DN 的一线治疗。
