What are new avenues for renal protection, in addition to RAAS inhibition?

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Abstract

Diabetic nephropathy is the leading cause of endstage renal disease, with both the incidence and prevalence continuing to increase worldwide. Current treatments include optimization of glycemic and blood pressure control by targeting the renin-angiotensin-aldosterone system (RAAS) with angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin II receptor blockers. More innovative strategies are needed to prevent and treat this disease. New agents and approaches have recently been described that have the potential to delay the progression of diabetic kidney disease and minimize the growing burden of endstage renal disease. Possible targets include the formation of advanced glycation end products (AGEs) and the AGE receptor, increased oxidative stress and inflammation, protein kinase C, endothelin receptors, growth factors and cytokines, the vitamin D receptor, Rho-associated kinases, and the renal sympathetic system. This article reviews these recent developments as potential therapeutic interventions that may prevent this disease, with targets generally beyond the RAAS. 

Original languageEnglish
Pages (from-to)100-110
Number of pages11
JournalCurrent Hypertension Reports
Volume14
Issue number2
DOIs
Publication statusPublished - Apr 2012
Externally publishedYes

Keywords

  • AGE formation inhibitors
  • AGE receptor antagonists
  • AGEs
  • Atrasentan
  • Bardoxolone methyl
  • Diabetic nephropathy
  • End-stage renal disease
  • Endothelin receptor antagonists
  • Fasudil
  • Growth factors
  • Kidney disease
  • Oxidative stress
  • Paricalcitol
  • Pentoxifylline
  • PKC
  • RAAS
  • Renal denervation
  • Renal protection
  • Renin-angiotensin- aldosterone system
  • ROCK
  • Ruboxistaurin
  • TGF-β inhibitors
  • Therapy

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