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Volume 26
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10.3390/ijms26178224
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Review

Diabetic Kidney Disease: From Pathophysiology to Regression of Albuminuria and Kidney Damage: Is It Possible?

by
Georgia Doumani
1,
Panagiotis Theofilis
1,
Aikaterini Vordoni
1,
Vasileios Thymis
1,
George Liapis
2,
Despina Smirloglou
1 and
Rigas G. Kalaitzidis
1,*
1
Center for Nephrology “G. Papadakis”, General Hospital of Nikaia-Piraeus “Ag. Panteleimon”,18454 Nikaia, Greece
2
1st Department of Pathology Medical School, National an Kapodistrian University of Athens, Laikon Hospital, 11627 Athens, Greece
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2025, 26(17), 8224; https://doi.org/10.3390/ijms26178224
Submission received: 23 July 2025 / Revised: 17 August 2025 / Accepted: 19 August 2025 / Published: 24 August 2025
(This article belongs to the Collection Latest Review Papers in Endocrinology and Metabolism)
Versions Notes

Abstract

Diabetes mellitus (DM) poses an increasingly high global health burden nowadays, while in adults, chronic kidney disease (CKD) associated with DM impacts 20–40% of those with the condition. Effective management of CKD in patients with diabetes necessitates a comprehensive, multidisciplinary approach. Numerous factors, including glomerular hyperfiltration, oxidative stress, inflammation, and hypoxia are linked to the advancement of diabetic kidney disease (DKD). Currently, no specific treatment for DKD has been established, prompting extensive exploration of new approaches. Renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter 2 inhibitors have demonstrated renoprotective effects in various human clinical trials. Additionally, glucagon-like peptide 1 receptor agonists and mineralocorticoid receptor antagonists have been reported as effective in managing DKD, while new therapeutic candidates are also under investigation, such as soluble guanylate cyclase activators and aldosterone synthase inhibitors. Recent evidence has shown that treating diabetic nephropathy by reducing albuminuria levels and retarding its progression is a complex skill. The purpose of this review is to support the impressive results that appear in reducing albuminuria and the progression of diabetic nephropathy with early and intensive combination treatment compared to the recently emerged conventional monotherapy, with agents that act on different pathophysiological mechanisms.
Keywords: type 2 diabetes mellitus; chronic kidney disease; albuminuria; renin-angiotensin-aldosterone system inhibitors; SGLT2 inhibitors; glucagon-like peptide 1 receptor agonists; mineralocorticoid receptor antagonists; aldosterone synthase inhibitors; combination treatment type 2 diabetes mellitus; chronic kidney disease; albuminuria; renin-angiotensin-aldosterone system inhibitors; SGLT2 inhibitors; glucagon-like peptide 1 receptor agonists; mineralocorticoid receptor antagonists; aldosterone synthase inhibitors; combination treatment

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MDPI and ACS Style

Doumani, G.; Theofilis, P.; Vordoni, A.; Thymis, V.; Liapis, G.; Smirloglou, D.; Kalaitzidis, R.G. Diabetic Kidney Disease: From Pathophysiology to Regression of Albuminuria and Kidney Damage: Is It Possible? Int. J. Mol. Sci. 2025, 26, 8224. https://doi.org/10.3390/ijms26178224

AMA Style

Doumani G, Theofilis P, Vordoni A, Thymis V, Liapis G, Smirloglou D, Kalaitzidis RG. Diabetic Kidney Disease: From Pathophysiology to Regression of Albuminuria and Kidney Damage: Is It Possible? International Journal of Molecular Sciences. 2025; 26(17):8224. https://doi.org/10.3390/ijms26178224

Chicago/Turabian Style

Doumani, Georgia, Panagiotis Theofilis, Aikaterini Vordoni, Vasileios Thymis, George Liapis, Despina Smirloglou, and Rigas G. Kalaitzidis. 2025. "Diabetic Kidney Disease: From Pathophysiology to Regression of Albuminuria and Kidney Damage: Is It Possible?" International Journal of Molecular Sciences 26, no. 17: 8224. https://doi.org/10.3390/ijms26178224

APA Style

Doumani, G., Theofilis, P., Vordoni, A., Thymis, V., Liapis, G., Smirloglou, D., & Kalaitzidis, R. G. (2025). Diabetic Kidney Disease: From Pathophysiology to Regression of Albuminuria and Kidney Damage: Is It Possible? International Journal of Molecular Sciences, 26(17), 8224. https://doi.org/10.3390/ijms26178224

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