Pharmacological Management of Diabetic Nephropathy

Curr Vasc Pharmacol. 2020;18(2):139-147. doi: 10.2174/1570161117666190405164749.

Abstract

Introduction: Diabetes mellitus (DM) is one of the most common diseases worldwide. Its adverse effects on several body organs, have made treatment of DM a priority. One of the most serious complications of DM is diabetic nephropathy (DN).

Objective: The aim of this review is to critically discuss available data on the pharmacological management of DN.

Methods: A comprehensive review of the literature was performed to identify studies assessing the impact of several drug classes on DN.

Results: Several studies have been conducted in order to find a novel and effective treatment of DN. So far, the cornerstone therapy of DN consists of renin-angiotensin system (RAS) inhibitors, agents that decrease the synthesis of intrarenal angiotensin II or block its receptors. Their antiproteinuric and antihypertensive effects can not only decelerate the progress of DN but prevent its onset as well. Novel antidiabetic drugs, such as sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide- 1 receptor agonists (GLP-1 RA), are promising agents in the therapy of DN, due to their positive effect on renal and cardiovascular adverse events. From lipid-lowering agents, atorvastatin improves DN up to stage 3 and substantially reduces CVD.

Conclusion: RAS inhibitors, SGLT-2i and GLP-1 agonists were found to be beneficial for the treatment of DN. Larger renal trials are needed in order to incorporate these drugs into the first line treatment of DN.

Keywords: Diabetic nephropathy; glucagon-like peptide-1 receptor agonists; pharmacological management; renin-angiotensin system inhibitors; sodium-glucose cotransporter 2 inhibitors..

Publication types

  • Review

MeSH terms

  • Angiotensin Receptor Antagonists / adverse effects
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Animals
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / physiopathology
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / drug therapy*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / physiopathology
  • Glucagon-Like Peptide-1 Receptor / agonists
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Hypolipidemic Agents / therapeutic use
  • Incretins / therapeutic use
  • Kidney / drug effects*
  • Kidney / physiopathology
  • Renin-Angiotensin System / drug effects*
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use
  • Treatment Outcome

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • GLP1R protein, human
  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Hypolipidemic Agents
  • Incretins
  • Sodium-Glucose Transporter 2 Inhibitors