Diabetic nephropathy: new mechanisms and pharmacological options

Abstract

Currently we observe the exponential growth of “diabetes in the world” and its consequences. What is our challenge?

The paradigm in the choice of medication for patients with diabetes has been modified from a “glucocentric” criterion to a “cardio-renal-metabolic” one, which has allowed us to combine some new concepts to establish the choice in treatment and avoid the appearance and/or the progression of cardiovascular and/or renal complications.

For decades we focused our objectives on risk factors (glycemic control, blood pressure, cholesterol). Today we must focus on individualizing the evaluation of cardiovascular risk.

However, “the true paradigm” is to understand that the root of the majority of risk factors and cardiorenal complications arises from the new and growing problem that we have not prioritized for decades as the initiating cause, which is “inflammation” as a consequence. of body weight increase in many world populations and in Argentina.

If we focus on kidney protection, we must understand that central fat is generally the early cause of the same alterations that we can see in diabetes and that it also generates its own, focal and segmental glomerulopathy.

We know that to avoid the appearance of kidney disease in diabetes, one must evaluate alterations such as albuminuria and glomerular filtration rate early.

Should we do the same in obesity? What is the right moment and what is the difficulty? It is important to know these difficulties in diagnosis to choose the appropriate treatment. We must consider that many of our patients share this “twin epidemic” of diabetes and obesity.

With respect to treatment, there have currently been changes in both the understanding of the pathophysiology and the decision to use drugs with a cardio-metabolic effect, in addition to the achievement of hypertensive goals, lipid alterations, and weight. The evidence has determined modifications in the diabetes and NKF guidelines that will be the topic of this dissertation.