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Pathophysiology of Diabetic Nephropathy

Chapter

Abstract

Diabetic nephropathy is the leading cause of end stage kidney disease, accounting for approximately 50 % of cases of end stage renal disease. Microalbuminuria is the earliest clinical manifestation of diabetic nephropathy. Microalbuminuria may progress to overt albuminuria, which is a hallmark of irreversible nephropathy and predicts progression of kidney disease. Many of the pathophysiological changes seen in the kidney in diabetic nephropathy result from prolonged hyperglycemia. The podocyte is one of the key targets in diabetic kidney disease and podocyte damage leads to foot process effacement and the development of proteinuria. While angiotensin converting enzyme inhibitors and angiotensin receptor blockers have long been used as the mainstay of treatment for diabetic nephropathy, targeted, effective new therapies are urgently needed.

Keywords

Albuminuria Hyperfiltration Hyperglycemia Mesangial expansion Renin-angiotensin system blockade 

Abbreviations

ACE

Angiotensin-converting enzyme

ACTH

Adrenocorticotropic hormone

AGEs

Advanced glycation end products

AKI

Acute kidney injury

ARBs

Angiotensin II receptor blockers

ATF6

Activating transcription factor 6

CKD

Chronic kidney diseases

CVD

Cardiovascular disease

DAMPs

Damage-associated molecular patterns

DKD

Diabetic kidney disease

DN

Diabetic nephropathy

eGFR

Estimated glomerular filtration rate

EMT

Epithelial-to-mesenchymal transition

ER

Endoplasmic reticulum

ESRD

End-stage renal disease

ET-1

Endothelin Receptor Antagonists

GBM

Glomerular basement membrane

IRE1

Inositol requiring enzyme 1

MCR

Melanocortin receptors

MMPs

Matrix metalloproteinases

NF-kB

Nuclear factor Kappa B

PERK

Protein-kinase-RNA-like ER kinase

RAGE

Receptors for AGE

RAS

Renin-angiotensin system

ROS

Reactive oxygen species

T2DM

Type 2 diabetes

UAE

Urinary albumin excretion

α-SMA

α-Smooth muscle actin

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Felsenstein Medical Research Center and Department of Nephrology and Hypertension, Rabin Medical CenterSackler School of Medicine, Tel-Aviv UniversityTel-AvivIsrael
  2. 2.Department of MedicineUniformed Services University of the Health SciencesBethesdaUSA

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