Review
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World J Diabetes. Jun 15, 2014; 5(3): 342-356
Published online Jun 15, 2014. doi: 10.4239/wjd.v5.i3.342
Clinical therapeutic strategies for early stage of diabetic kidney disease
Munehiro Kitada, Keizo Kanasaki, Daisuke Koya
Munehiro Kitada, Keizo Kanasaki, Daisuke Koya, Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa 920-0293, Japan
Author contributions: All authors contributed to this work.
Supported by A Grant from Novo Nordisk Pharma, to Kitada M; A Grant-in-Aid for Scientific Research (C) to Kitada M, No. 24591218; A Grant for Promoted Research from Kanazawa Medical University to Kitada M, No. S2012-4; A Grant-in-Aid for Scientific Research (B) to Koya D, No. 25282028; A Grant-in-Aid for Challenging Exploratory Research to Koya D, No. 25670414; A grant for Specially Promoted Research from Kanazawa Medical University to Koya D, No. SR2012-06; and the 4th Annual Research Award Grant of the Japanese Society of Anti-Aging Medicine, to Koya D
Correspondence to: Daisuke Koya, MD, PhD, Department of Diabetology and Endocrinology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa 920-0293, Japan. koya0516@kanazawa-med.ac.jp
Telephone: +81-76-2862211 Fax: +81-76-2866927
Received: November 26, 2013
Revised: March 8, 2014
Accepted: April 17, 2014
Published online: June 15, 2014
Processing time: 202 Days and 8 Hours
Abstract

Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease, leading to end-stage renal disease and cardiovascular disease. The overall number of patients with DKD will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Based on landmark clinical trials, DKD has become preventable by controlling conventional factors, including hyperglycemia and hypertension, with multifactorial therapy; however, the remaining risk of DKD progression is still high. In this review, we show the importance of targeting remission/regression of microalbuminuria in type 2 diabetic patients, which may protect against the progression of DKD and cardiovascular events. To achieve remission/regression of microalbuminuria, several steps are important, including the early detection of microalbuminuria with continuous screening, targeting HbA1c < 7.0% for glucose control, the use of renin angiotensin system inhibitors to control blood pressure, the use of statins or fibrates to control dyslipidemia, and multifactorial treatment. Reducing microalbuminuria is therefore an important therapeutic goal, and the absence of microalbuminuria could be a pivotal biomarker of therapeutic success in diabetic patients. Other therapies, including vitamin D receptor activation, uric acid-lowering drugs, and incretin-related drugs, may also be promising for the prevention of DKD progression.

Keywords: Diabetic kidney disease; Glycemic control; Renin-angiotensin system inhibitor; Multifactorial therapy; Remission and regression of albuminuria

Core tip: We show the significance of targeting the remission/regression of microalbuminuria in type 2 diabetic patients, leading to protection against the progression of diabetic kidney disease (DKD) and cardiovascular events. To achieve the remission/regression of microalbuminuria, the multifactorial intervention and the early detection of microalbuminuria with continuous screening is important, as management of DKD. Multifactorial intervention includes glucose, blood pressure and lipid control. Additionally, other therapies, including vitamin D receptor activation, uric acid-lowering medicine and incretin-related medicines may be promising for preventing the progression of DKD. We review the current standard treatment for DKD and other prospective therapies for DKD.