Pharmacological and Nutritional Advances in Diabetic Nephropathy

Abstract

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide, accounting for 50,0 % of cases in developed countries. Despite conventional treatment based on strict glycemic control and renin-angiotensin-aldosterone system (RAAS) blockade, this approach only delays disease progression, driving the search for innovative therapeutic strategies. This study analyzes recent advances in the comprehensive therapy of diabetic nephropathy. A narrative review of specialized literature (2020-2025) was conducted using PubMed, Google Scholar, and Elsevier databases, employing MeSH terms combined with Boolean operators: (Diabetic nephropathy) and (management or treatment) and (advances or progress). Randomized clinical trials and multicenter studies with human evidence were included. Therapeutic advances focused on three pillars: 1) renoprotective drugs (SGLT2 inhibitors, GLP-1 agonists, and finerenone) that reduce albuminuria, cardiovascular events, and progression to renal failure; 2) personalized nutritional strategies (low-protein, low-salt, and low-carbohydrate diet) to mitigate oxidative stress and inflammation; and 3) emerging therapies such as mesenchymal stem cells and traditional Chinese medicine, still in the investigational phase. Comprehensive therapy for DN is evolving toward a multimodal approach that transcends glycemic control, integrating innovative pharmacology, personalized nutrition, and emerging therapies. Standardization of protocols and validation through prospective clinical trials are essential for effective clinical implementation.