Diabetic nephropathy: important pathophysiologic mechanisms.

With the global epidemic of type 2 diabetes mellitus, diabetes has become the leading cause of end stage renal failure (ESRF) in most Western countries. Approximately 20-30% of all diabetic subjects will develop evidence of diabetic nephropathy, which represents a continuum from microalbuminuria, to overt nephropathy or macroalbuminuria, and finally ESRF. While there have been significant breakthroughs in the last decade with regards to the prevention and treatment of diabetic kidney disease, in particular blockade of the renin angiotensin system, there is a vital need to identify and target novel pathophysiologic pathways such as advanced glycation which appear to be centrally involved in diabetic renal disease in order to reduce the rising burden of this disease.