Blood Pressure Control in Patients with Diabetic Kidney Disease

Comprehending the Role of Metabolic and Hemodynamic Factors Alongside Different Signaling Pathways in the Pathogenesis of Diabetic Nephropathy

Diabetic nephropathy (DN) is a progressive microvascular disorder of diabetes that contributes as a primary reason for end-stage renal disease worldwide. The pathological hallmarks of DN include diffuse mesangial expansion, thicker basement membrane of glomeruli, and arteriole hyalinosis. Hypertension and chronic hyperglycemia are the primary risk factors contributing to the occurrence of DN. The complex pathophysiology of DN involves the interplay amongst metabolic and hemodynamic pathways, growth factors and cytokines production, oxidative stress, and ultimately impaired kidney function. Hyperglycemia-induced vascular dysfunction is the main pathological mechanism that initiates DN. However, several other pathogenic mechanisms, such as oxidative stress, inflammatory cell infiltration, and fibrosis, contribute to disease progression. Different vasoactive hormone processes, including endothelin and renin-angiotensin, are activated as a part of the pathophysiology of DN, which also involves increased intraglomerular and systemic pressure. The pathophysiology of DN will continue to be better understood because of recent developments in genomics and molecular biology, but attempts to develop a comprehensive theory that explains all existing cellular and biochemical pathways have been thwarted by the disease's multifactorial nature. This review extensively discusses the current understanding regarding the metabolic and hemodynamic pathological mechanisms, along with other signaling pathways and molecules responsible for the pathogenesis of DN. This work will encourage a greater in-depth understanding and investigation of the present status of the biochemical mechanistic processes underlying the pathogenesis of DN, which may assist in the determination of different biomarkers and help in the design and development of novel drug candidates in the near future.

Association Between Atherogenic, Thrombogenic, and Lipophilic Indices and the Odds of Diabetic Nephropathy in Type 2 Diabetic Patients: A Case–Control Study

The quality of fats in the diet affects the development of chronic kidney disease. In this study, we aimed to understand the relationship between dietary fat markers and the risk of diabetic nephropathy (DN) in patients with Type 2 diabetes (T2DM).In this case retrospective study, 309 patients with T2DM (151 with DN, and 158 without DN) were included. A 147 item questionnaire measuring food frequency and the International Physical Activity Questionnaire (IPAQ) were used. Anthropometric indices, and biochemical factors were measured or recorded from the patient's files. Quantitative Insulin Sensitivity Check Index (QUICKI), Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR), atherogenic, thrombogenic, and lipophilic indices were calculated. Modified nutritionist IV software and the USDA composition table were used. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using a case–control design. Age, BMI, energy in Model 1 and physical activity, blood glucose, level of insulin, lipid profile, creatinine level, and CRP were adjusted as interventions in Model 2. Compared to control subjects, patients with diabetic nephropathy (DN) had a significantly higher body mass index (BMI), level of fasting insulin, fasting blood sugar (FBS), total cholesterol (TC), triglyceride (TG), low‐density lipoprotein cholesterol (LDL‐C) and creatinine as well as lower intakes of energy, carbohydrates, mono—and polyunsaturated fatty acids, fiber, and cholesterol compared to controls. After adjustment for possible confounders, patients in the highest quartile of the atherogenic (OR: 3.49, 95% CI: 1.65–7.41), thrombogenic (OR: 4.3, 95% CI: 1.86–8.72), and lipophilic (OR: 3.50, 95% CI: 1.62–7.52) indices had significantly higher odds of DN than those in the lowest quartile. There was a considerable relationship between higher dietary fat indices (including atherogenic, thrombogenic, and lipophilic indices) and a higher chance of developing nephropathy.

A New Era in Diabetic Kidney Disease Treatment: The Four Pillars and Strategies to Build Beyond

Diabetic kidney disease (DKD) is a prevalent and complex disease among patients with diabetes in Korea, requiring comprehensive treatment strategies. Traditional management strategies targeting blood pressure, blood sugar, lipid, and lifestyles are foundational approaches of DKD treatment, each of them still holding importance in current paradigms. The four pillars, renin-angiotensin system(RAS) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and non-steroidal mineralocorticoid receptor antagonists (nsMRA) can enhance DKD treatment. Expanding beyond these pillars with future-oriented pillars including precision medicine, digital health, gut health, anti-inflammatory/fibrotic agents, psychosocial/behavioral health, and regenerative medicine can further advance DKD treatment strategies, offering a more cohesive framework which shifts a disease-centered approach to a patient-centered approach.

Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

Diabetic kidney disease (DKD) is a major microvascular complication of both type 1 and type 2 diabetes. DKD is characterised by injury to both glomerular and tubular compartments, leading to kidney dysfunction over time. It is one of the most common causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Persistent high blood glucose levels can damage the small blood vessels in the kidneys, impairing their ability to filter waste and fluids from the blood effectively. Other factors like high blood pressure (hypertension), genetics, and lifestyle habits can also contribute to the development and progression of DKD. The key features of renal complications of diabetes include morphological and functional alterations to renal glomeruli and tubules leading to mesangial expansion, glomerulosclerosis, homogenous thickening of the glomerular basement membrane (GBM), albuminuria, tubulointerstitial fibrosis and progressive decline in renal function. In advanced stages, DKD may require treatments such as dialysis or kidney transplant to sustain life. Therefore, early detection and proactive management of diabetes and its complications are crucial in preventing DKD and preserving kidney function.