Diabetic Nephropathy: Pathophysiology, Diagnosis and Treatment

Abstract

Diabetic nephropathy is a serious complication of diabetes mellitus, which can progress to end-stage renal disease. The pathology involves glomerular hypertension, renal hypertrophy and protein deposits in the extracellular matrix, resulting in inflammation, fibrosis and glomerulosclerosis. This article aims to describe the pathophysiology, diagnosis and treatment of diabetic nephropathy, based on a review of current literature. To this end, we analyzed articles and clinical studies published until July 2024, using databases such as PubMed, Google Scholar and the Cochrane Library, focusing on key terms related to diabetic nephropathy. It was observed that albuminuria, estimated glomerular filtration rate and the presence of
diabetic retinopathy are important markers of diabetic nephropathy (1). Emerging biomarkers such as NGAL and KIM-1 hold promise for early detection of kidney injury (11). Treatment, without specific therapies, focuses on glycemic and blood pressure control, albuminuria management and lifestyle changes, with the use of medications such as ACE inhibitors and iSGLT2 for renal protection and reduction of cardiovascular complications. It is concluded that, despite interventions, progression to end-stage renal disease is common, highlighting the need for new therapies and a better understanding of the underlying mechanisms, in addition to the identification of reliable biomarkers to monitor disease progression.