Diabetes Clinic, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy.
Division of Nephrology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy.
Int J Mol Sci. 2024 Apr 3;25(7):3969. doi: 10.3390/ijms25073969.
Diabetic kidney disease (DKD) is a chronic microvascular complication in patients with diabetes mellitus (DM) and the leading cause of end-stage kidney disease (ESKD). Although glomerulosclerosis, tubular injury and interstitial fibrosis are typical damages of DKD, the interplay of different processes (metabolic factors, oxidative stress, inflammatory pathway, fibrotic signaling, and hemodynamic mechanisms) appears to drive the onset and progression of DKD. A growing understanding of the pathogenetic mechanisms, and the development of new therapeutics, is opening the way for a new era of nephroprotection based on precision-medicine approaches. This review summarizes the therapeutic options linked to specific molecular mechanisms of DKD, including renin-angiotensin-aldosterone system blockers, SGLT2 inhibitors, mineralocorticoid receptor antagonists, glucagon-like peptide-1 receptor agonists, endothelin receptor antagonists, and aldosterone synthase inhibitors. In a new era of nephroprotection, these drugs, as pillars of personalized medicine, can improve renal outcomes and enhance the quality of life for individuals with DKD.
糖尿病肾病（DKD）是糖尿病（DM）患者的一种慢性微血管并发症，也是终末期肾病（ESKD）的主要原因。尽管肾小球硬化、肾小管损伤和间质纤维化是 DKD 的典型损伤，但不同过程（代谢因素、氧化应激、炎症途径、纤维化信号和血液动力学机制）的相互作用似乎驱动了 DKD 的发生和进展。对发病机制的认识不断加深，以及新疗法的发展，为基于精准医学方法的肾脏保护新时代开辟了道路。本文综述了与 DKD 特定分子机制相关的治疗选择，包括肾素-血管紧张素-醛固酮系统阻滞剂、SGLT2 抑制剂、盐皮质激素受体拮抗剂、胰高血糖素样肽-1 受体激动剂、内皮素受体拮抗剂和醛固酮合酶抑制剂。在肾脏保护的新时代，这些药物作为个体化医学的支柱，可以改善肾脏结局，提高 DKD 患者的生活质量。
