Abstract
Diabetic nephropathy is a clinical syndrome based on specific morphologic and functional changes of the kidneys in patients with diabetes. It occurs as a result of diabetic metabolic disorder and not precisely defined genetic predisposition.
Development of kidney disease in patients with diabetes mellitus usually leads to worsened quality of life and development of further complications, especially cardiovascular ones. At the same time, ethical issues come to the forefront, some of them previously unknown in practice (for example discontinuing dialysis treatment, social exclusion, problems associated with self-care inability, etc.).
It is thus important to screen patients for nephropathy, to classify it properly and to try to treat it intensely. The standard components of treatment of diabetic nephropathy include lifestyle adjustments, achieving tight metabolic control, i.e. diabetes compensation, blood lipid management, normalisation of blood pressure, and use of drugs from the RAAS blocker group, which have been proven to lower proteinuria and help slower further deterioration of renal function.
There are currently many new substances being tested, which show great promise for both primary and secondary prevention of diabetic nephropathy. Among those are new oral antidiabetics (OAD), i.e.
DDP-4 inhibitors (gliptins) and SGLT-2 inhibitors (gliflozins). The renal protective effects of PPAR-? agonists (glitazons) seem to be much less significant than it was initially assumed.
Among the general renal protective effects of gliptins are improved endothelial function, lowered blood pressure, reduced inflammatory response and delayed atherosclerosis progression; among its specific effects are lowered albuminuria, urinary excretion of 8-isoprostan and lessened signs of insterstitial fibrosis. The main renal protective effect of gliflozins is achieved by lowering glomerular hyper-filtration.
Even though the initial results of the studies involving the new OADs show much promise, it is necessary to wait for the results of the currently ongoing large scale studies (CREDENCE).