Inhibition and reversibility of renal changes: lessons from diabetic kidney disease.

UNLABELLED: This review describes the clinical characteristics of kidney disease in patients with diabetes in terms of functional and morphological changes, and summarizes the risk factors for progression of disease and the knowledge available today on various treatment modalities. New insights into the pathogenesis of kidney disease in diabetic patients are also reviewed in the context of the nephropathy of Fabry disease. Newly recognized pathways that play a role in the development/progression of kidney disease in patients with diabetes include metabolic factors, (e.g. advanced glycation end products), intracellular signalling proteins (e.g. protein kinase C) and growth factors/cytokines (e.g. growth hormone, insulin-like growth factors, transforming growth factor beta and vascular endothelial growth factor). As classic examples of progress in our understanding of the pathogenesis of kidney disease in patients with diabetes, the relationship between two growth factor/cytokine-systems and the development of diabetic kidney disease is reviewed, including a description of well-known or potential therapeutic strategies targeting the two systems.

CONCLUSION: It is hoped that the new pathogenetic insights into diabetic kidney disease may facilitate the development of new drugs for the treatment of this and related kidney diseases.