While much progress has been made advancing our knowledge in the
Pathogenetic mechanisms of diabetic kidney disease (DKD) including the role of
oxidative stress, inflammation and fibrosis as eloquently presented (by N. Sharma, J.
Lee and I.M. McFarlane) in chapter 6 of this volume, this progress has not been
adequately translated into therapeutic modalities to aid clinicians handling the rapid
rise of DKD that is associated with significant increase in morbidity and mortality in
the USA and around the globe. For example, agents that block the renin angiotensin
aldosterone system (RAAS) such as angiotensin converting enzyme (ACE) inhibitors
and angiotensin receptor blockers (ARBs) are only effective in halting the progress of
DKD in a minority of patients.
In this chapter we discuss the major therapeutic targets that are currently under
investigations in clinical trials, highlighting the pathogenetic mechanisms and the
therapeutic rationale for these potential interventions as future preventive and
therapeutic strategies in DKD, a rapidly growing epidemic.
Keywords: Chronic kidney disease, Diabetes, Future directions, Nephropathy.
