Background: Diabetic kidney disease (DKD) has emerged as the leading cause of end-stage renal disease (ESRD) internationally due to the rising prevalence of diabetes mellitus (DM). DKD is not only a secondary disease caused by continuous glucose metabolism disorder, but also a chronic inflammatory disease characterized by high expression of pro-inflammatory factors and a large number of immune cell infiltration. Macrophages are the main immune cells infiltrating in the kidney, which can polarize into pro-inflammatory M1 and anti-inflammatory M2 phenotypes under the high control of the surrounding microenvironment. M1 and M2 macrophages can coexist at times but have distinct functional characteristics in the same population. Summary: Studies have confirmed that the accumulation and polarization of macrophages is a risk factor for the progression of DKD. Natural products contribute to alleviate kidney damage by suppressing macrophage recruitment and activation, which may be a potential treatment for DKD. Key Messages: This review describes the phenotype and polarization of macrophages, as well as their role in DKD animal models and patients, outlines the molecular mechanism of macrophages recruitment and activation in DKD, and further discusses the cross-action between macrophages and other kidney cells, summarizes emphatically natural products targeting macrophages, which is of great significance for future basic research and clinical management of DKD.
Wang et al. (Thu,) studied this question.