Comprehensive insights into diabetic nephropathy: pathophysiology, clinical features, and emerging treatments

Diabetic nephropathy (DN) is a leading cause of chronic kidney disease and end-stage renal disease globally, affecting 20–50% of diabetic patients. DN is characterized by albuminuria, retinopathy, and progressive reduction in glomerular filtration rate. The pathophysiology involves chronic hyperglycemia, protein glycosylation, mesangial matrix deposition, glomerular hemodynamic alterations, cytokine release, and renin-angiotensin-aldosterone system activation, leading to kidney damage. Differences in DN mechanisms between type 1 and type 2 diabetes are influenced by additional factors such as aging, obesity, and dyslipidemia. Prevention strategies focus on lifestyle modifications and regular screening. Pharmacological management includes tight glycemic control, blood pressure regulation, renin-angiotensin-aldosterone system blockade, and novel agents like sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. Emerging therapies targeting inflammatory pathways and innovative medications offer promising avenues for future research. Comprehensive management integrating early detection and advanced pharmacological interventions is crucial to mitigating DN progression and improving patient outcomes.