Resolving the VEGF paradox in DKD: VEGFR1 blockade shows promising renoprotection.

Diabetic kidney disease remains a major clinical challenge despite advances in renoprotective therapies. In this issue of Kidney International, Qi et al. report that selective modulation of the vascular endothelial growth factor (VEGF) system differentially affects diabetic kidney disease progression across multiple advanced diabetic models. Whereas VEGF-A or VEGF receptor 2 inhibition exacerbated albuminuria, targeted VEGF receptor 1 blockade consistently conferred renoprotection, including in established disease. These findings clarify prior conflicting data and identify VEGF receptor 1 inhibition as a therapeutic strategy for diabetic kidney disease.