DIFFERENT METABOLIC PATHWAYS IN DIABETIC KIDNEY DISEASE AND RECENT ADVANCES IN SLOWING DISEASE PROGRESSION

Globally, diabetic kidney disease (DKD) is the leading cause of end-stage renal disease. As the most common microvascular complication of diabetes, DKD is a thorny, clinical problem in terms of its diagnosis and management. Intensive glucose control in DKD could slow down but not significantly halt disease progression. Revisiting the tremendous advances that have occurred in the field would enhance recognition of DKD pathogenesis as well as improve our understanding of translational science in DKD in this new era. In this review, we summarize advances in the understanding the local microenvironmental changes in diabetic kidneys and discuss the involvement of genetic factors in the pathogenesis of DKD. The review also focuses on understanding how the hemodynamic, metabolic, inflammatory, and alternative pathways are all entangled in pathogenesis of DKD and discuss various conventional and novel therapeutic targets that may play role in slowing DKD.