According to the National Kidney Foundation, 26 million adults in the US currently have chronic kidney disease (CKD). Although CKD results from various etiologies, diabetes mellitus and hypertension are the major causes of this disease in the US. Diabetes mellitus, which can lead to diabetic nephropathy, is the single leading cause of kidney failure in the US, accounting for approximately 45% of patients who begin treatment for kidney failure each year. (For example, in 2001 more than 40,000 people with diabetes developed kidney failure.) Although ACE inhibitors and ARBs are the current standard of care for CKD, they do not cure the disease, and patients progressively lose kidney function while on these medications, albeit significantly less rapidly than if left untreated. For many years the prevailing view of the pathogenesis of CKD has been that declines in glomerular filtration rate (GFR) that lead to end-stage renal disease (ESRD) are caused by an irreversible loss of nephrons to fibrotic disease. However, a substantial body of epidemiological and structural data in diabetic patients with CKD has failed to establish a cause-effect relationship between fibrosis-mediated nephron loss and declining renal function. An emerging view is that CKD in diabetic patients is a disease of chronic inflammation and oxidative stress characterized by reduced nephron function secondary to endothelial dysfunction, mesangial expansion, and other inflammatory processes without significant fibrosis-mediated nephron loss. This suggests that the pathological basis of CKD in diabetic patients is, in part, chronic renal inflammation with an etiology similar to chronic vascular inflammation in cardiovascular disease. This explains why most diabetics with CKD also have cardiovascular disease and more frequently succumb to this comorbidity. As such, novel therapeutics that target inflammatory pathways in the kidney and vasculature may have utility in improving CKD outcomes. Evidence supporting the role of inflammation in the development and progression of CKD, together with recent results of clinical trials of an innovative drug that modulates inflammatory pathways in diabetic patients with CKD, will be presented at this symposium.
Networking reception to follow.
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