Diabetic nephropathy is a leading cause of
end-stage renal disease worldwide. The mainstay of treatment has been
glycemic control and blood pressure lowering using agents blocking the renin-angiotensin system. Clinical trials are currently under way using novel agents for the treatment of patients with
diabetic nephropathy. Promising agents emerging from some of the completed trials include
pirfenidone and
bardoxolone methyl, which have been shown in two recent randomized controlled trials in patients with
diabetic nephropathy to result in an improved estimated glomerular filtration rate compared to placebo. Also,
paricalcitol has been shown to decrease the urinary
albumin-to-
creatinine ratio, whereas
sulodexide failed to do so in a large randomized double-blind placebo-controlled trial. Of note,
pyridoxamine has also shown promise in the treatment of
diabetic nephropathy if started early in the disease course. These preliminary trials have shown significant promise for managing patients with
diabetic nephropathy, sparking active research in this field and providing the rationale for further clinical testing in long-term, hard-outcomes trials.