The New Biology of Diabetic Kidney Disease-Mechanisms and Therapeutic Implications

Endocr Rev. 2020 Apr 1;41(2):202-231. doi: 10.1210/endrev/bnz010.


Diabetic kidney disease remains the most common cause of end-stage kidney disease in the world. Despite reductions in incidence rates of myocardial infarction and stroke in people with diabetes over the past 3 decades, the risk of diabetic kidney disease has remained unchanged, and may even be increasing in younger individuals afflicted with this disease. Accordingly, changes in public health policy have to be implemented to address the root causes of diabetic kidney disease, including the rise of obesity and diabetes, in addition to the use of safe and effective pharmacological agents to prevent cardiorenal complications in people with diabetes. The aim of this article is to review the mechanisms of pathogenesis and therapies that are either in clinical practice or that are emerging in clinical development programs for potential use to treat diabetic kidney disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Inflammatory Agents / pharmacology*
  • Diabetic Nephropathies / drug therapy*
  • Diabetic Nephropathies / etiology*
  • Dipeptidyl-Peptidase IV Inhibitors / pharmacology*
  • Endothelin Receptor Antagonists / pharmacology*
  • Glucagon-Like Peptide-1 Receptor / agonists*
  • Humans
  • Hypoglycemic Agents / pharmacology*
  • Mineralocorticoid Receptor Antagonists / pharmacology*
  • Sodium-Glucose Transporter 2 Inhibitors / pharmacology*


  • Anti-Inflammatory Agents
  • Dipeptidyl-Peptidase IV Inhibitors
  • Endothelin Receptor Antagonists
  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Mineralocorticoid Receptor Antagonists
  • Sodium-Glucose Transporter 2 Inhibitors