Key result
Novel therapeutic approaches for diabetic nephropathy have yielded a disappointingly low number of successfully implemented renoprotective molecules in clinical practice over the last two decades.
Future therapeutic approaches for diabetic nephropathy must be tested on top of optimal RAAS blockade, as few novel drugs have successfully reached clinical practice.
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Clinicians should await robust data before new agents; leaves open effective add-on testing atop RAAS blockade.
INTRODUCTION: Diabetes mellitus is increasingly common worldwide and is expected to affect 592 million people by 2035. The kidney is often involved. A key goal in treating diabetes is to reduce the risk of development of kidney disease and, if kidney disease is already present, to delay the progression to end-stage renal disease (ESRD). This represents a social and ethical issue, as a significant proportion of patients reaching ESRD in developing countries do not have access to renal replacement therapy. AREAS COVERED: The present review focuses on novel therapeutic approaches for diabetic nephropathy (DN), implemented on the basis of recent insights on its pathophysiology, which might complement the effects of single inhibition of the renin-angiotensin-aldosterone system (RAAS), the cornerstone of renoprotective interventions in diabetes, along with glycemic and blood pressure control. EXPERT OPINION: Although a plethora of new treatment options has arisen from experimental studies, the number of novel renoprotective molecules successfully implemented in clinical practice over the last two decades is disappointingly low. Thus, new investigational strategies and diagnostic tools - including the appropriate choice of relevant renal end points and the study of urinary proteome of patients - will be as important as new therapeutic interventions to fight DN. Finally, in spite of huge financial interests in replacing the less expensive ACE inhibitors and angiotensin II receptor blockers with newer drugs, any future therapeutic approach has to be tested on top of - rather than instead of - optimal RAAS blockade.
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Gentile et al. (2014) conducted a review in Diabetic nephropathy. Novel therapeutic approaches was evaluated. Novel therapeutic approaches for diabetic nephropathy have yielded a disappointingly low number of successfully implemented renoprotective molecules in clinical practice over the last two decades.
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