Pathophysiological mechanisms, potential biomarkers, and therapeutic interventions in diabetic nephropathy

Diabetic nephropathy (DN) is a diabetic complication that leads to the progressive deterioration of kidney function. Oxidative stress and inflammation play crucial roles in the pathogenesis of DN. Oral hypoglycemic agents such as sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase 4 inhibitors show renal protective effects and help in slowing the progression of the disease. Emerging therapeutic targets, including phosphodiesterase inhibitors, Vitamin D analogues, and others, are being explored for treating DN. The development of newer biomarkers needs more attention and clinical acceptance for the timely diagnosis and management of DN. The present review attempts to discuss the different stages of DN, the pathophysiological mechanisms involved in DN development and progression, and potential biomarkers (Neutrophil Gelatinase-Associated Lipocalin, β2-microglobulin, Kidney Injury Molecule-1, Serum homocysteine, β-trace protein, Angiotensinogen, Osteopontin, Urinary exosomes, MicroRNAs) and therapeutic approaches for the effective management of DN.