Diabetes mellitus has become a worldwide epidemic affecting nearly all areas of developing and developed countries. Nearly half of all patients with diabetes, type 1 and 2, will develop diabetic kidney disease (DKD) if they do not die prematurely from cardiovascular disease. Diabetic kidney disease is associated with a high cardiovascular mortality even in its early stages and about a third of patients with DKD will progress to end stage renal disease (ESRD). Presently, therapy for DKD is limited primarily to inhibitors of the renin angiotensin system, treatment of comorbidities, and life style modifications. The role of reactive oxidant species (ROS) in the pathogenesis of DKD has been demonstrated in numerous studies. However, the implementation of antioxidant therapy for DKD has been inadequate. The current review addresses the role of ROS in the pathogenesis of DKD and discusses current and potential novel treatment modalities.
Methodology: A comprehensive search of the literature was performed using MEDLINE and PubMed covering the period between 1966 and September 2009. The search for literature included only articles written in English. An article was rejected if it was clearly a letter or case report. The terms used for PubMed and Medline searches were: oxidative stress, reactive oxidant species, oxygen free radicals, diabetic nephropathy, and diabetic kidney disease. Formal inclusion and exclusion criteria were not defined for this review. The authors performed the analyses and statistical judgments in this review, and evaluated and identified articles for eligibility based on 4 criteria: 1) scientific relevance, 2) study design, 3) target population and 4) outcome.