New Tubulocentric Insights for Diabetic Nephropathy: From Pathophysiology to Treatment
Abstract
The prevalence of diabetes is increasing worldwide, and one of the most important complications, diabetic nephropathy, constitutes a significant global health care and socioeconomic burden. Glomerular dysfunction is a major factor in the development and progression of diabetic nephropathy. However, emerging evidence suggests that tubular damage also plays an important role in the pathogenesis of diabetic nephropathy. This tubulocentric view shifts the focus markedly from glomeruli to proximal tubules, which might have an important role as a trigger or a driver in the early development and progression of diabetic nephropathy. Accordingly, numerous studies have focused on several different tubular damage markers that are clinically indicated as potential biomarkers for the early detection of diabetic nephropathy. Furthermore, these findings are relevant for identifying therapeutics for diabetic nephropathy that target the proximal tubules. This review outlines new tubulocentric insights into diabetic nephropathy, from pathophysiological mechanisms to diagnostic and therapeutic approaches.
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