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Treatment of albuminuria due to diabetic nephropathy: recent trial results

Edward J Horwitz & Jeffrey R Schelling

Diabetic nephropathy is overwhelmingly the most common cause of chronic kidney disease, and is generally characterized by albuminuria in those patients destined to progress to end stage renal disease. To date, there are few interventions other than glucose and blood pressure control that have reliably been shown to modify albuminuria and alter the course of diabetic nephropathy. This review highlights recently completed and ongoing diabetic nephropathy clinical trials that have employed albuminuria as a primary end point. There is a trend toward development of drugs that target non-traditional mechanisms, especially anti-inflammatory, antioxidant and antifibrotic agents, which raises optimism that abrogation of multiple pathophysiologic pathways will yield additive benefits and improve diabetic nephropathy outcomes.