Diabetes and kidney disease

Diabetes mellitus is a worldwide epidemic. Its prevalence is on a steep rise and is more pronounced in India making it the ‘diabetes capital of the world’. There is also a parallel increase in the prevalence of diabetic nephropathy and is now the single most common cause of end-stage kidney disease leading to significant morbidity and mortality as well as accounts for a tremendous burden on the health care costs. It is also shown that the presence of diabetes increases the risk and progression of non-diabetic kidney disease. Currently available therapies aim at optimizing glycemic control and systemic blood pressure involving the blockade of the renin-angiotensin-aldosterone system although, have shown beneficial effect, the reduction in progression of the disease has been modest at best. This article reviews current treatment options and provides an overview of novel therapeutic agents that hold great potential for the treatment of diabetic kidney disease as well as to emphasize upon the importance of considering the possibility of a potentially reversible non-diabetic renal disease in diabetic patients with kidney involvement.