Experimental and Alternative Therapy Targeting Oxidative Stress in Diabetic Kidney Disease: A Mini-Review

Diabetic Kidney Disease (DKD), the most recently adopted term for Chronic Kidney Disease (CKD) in patients with Diabetes Mellitus (DM): it has a prevalence of 20-40% in this group, and leads to an overall Hazard Ratio of 3.16 (95% CI 3.0,3.4) for all-cause mortality adjusted by age and sex, compared to the general population in some countries [1,2]. Early recognition of clinical changes include screening for albuminuria performed by urinary albumin-to-creatinine ratio in a random spot urine collection, and estimation of Glomerular Filtration Rate (eGFR). An increased urinary albumin excretion of ≥30mg/g Cr and/or an eGFR<60ml/min/1.73m2 are considered abnormal [3]. The main target for prevention and management of DKD is glycemic control, normalization of blood pressure, smoking cessation, reduction of salt intake, and prevention of infections that may precipitate a fast increase of albuminuria or reduction of eGFR [4,5]. Structural and pathological changes observed in DKD are increased glomerular basement membrane width, diffuse mesangial sclerosis, hyalinosis, microaneurysm, and hyaline arteriosclerosis. Forty to 50% of patients developing proteinuria have Kimmelstiel-Wilson nodules, defined as areas of extreme mesangial expansion [5].