Macrophages and diabetic nephropathy.

Evidence from renal biopsies has shown that macrophage accumulation in diabetic kidneys predicts declining renal function, suggesting a pathogenic role for these cells in diabetic nephropathy. Further evidence from animal models has shown that macrophages are the major immune cells infiltrating the kidney in type 1 and type 2 diabetes, and that they contribute to the development of renal injury and sclerosis. This review examines macrophages in human and experimental diabetic nephropathy, exploring the mechanisms of macrophage recruitment and activation, and the process of macrophage-mediated injury in diabetic kidneys. The ability of current therapies and novel anti-inflammatory treatments to reduce macrophage-mediated injury in diabetic kidneys also is considered, which has important implications for the future management of patients with diabetic nephropathy.