New modalities for treatment of diabetic nephropathy: a mini review

Background and aims: Diabetic nephropathy (DN) is the most common cause of endstage renal failure which could increase the risk of cardiovascular disease and morbidity and mortality in patients. The aim of this study was to investigate new modalities for treatment of diabetic nephropathy. Methods: This study was a mini-review research to investigate drugs that are used for DN treatment. Results: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptors blocker (ARB) are the bases of DN treatment during recent decades. Due to some of adverse reactions of these drugs like hyperkalemia and chronic cough, other drugs such as non dihydropridin Ca channel blockers, uric acid lowering drugs, renin antagonists, lipid lowering agents, oral hypoglycemic agents such as Thiazolidinediones, Vitamin D and selective endothelin receptor antagonists have been used in some studies for decreasing proteinuria and slowing progression of DN. The results of these studies are different and controversial in some cases. Conclusion: The cornerstone of diabetic nephropathy is prescription of angiotensin receptor antagonists or angiotensin converting enzyme inhibitors or combination of two classes of drugs. For increasing the antiproteinuric effect of treatment or occurring the adverse effects of these drugs, (especially hyperkalemia), other agents such as Ca channel blockers, direct renin inhibitors, thioglithazons, uric acid lowering drugs or vitamin D may be added or replaced.