A Comprehensive Review of Diabetic Nephropathy and its Management by Phytomedicine

Abstract

Diabetic nephropathy (DN) is a prevalent microvascular complication of diabetes mellitus and constitutes the principal cause of both cardiovascular morbidity and end-stage renal disease (ESRD) in this population. Epidemiological data indicate that up to 50% of individuals with diabetes will develop DN. Disease initiation and progression are multifactorial; chronic hyperglycemia evokes oxidative stress through excessive generation of short-lived free radicals. Although the radicals themselves are transient, their downstream macromolecular damage—to lipids, proteins, and DNA—persists and serves as a measurable surrogate of oxidative burden. Persistent albuminuria, accompanied by a progressive decline in glomerular filtration rate (GFR), is the clinical hallmark of DN, yet phenotypic expression is heterogeneous. Consequently, the umbrella term “diabetic kidney disease” (DKD) is now applied to all diabetic patients with albuminuria and/or impaired renal function. The present review synthesizes current evidence on botanical and conventional therapeutics that modulate the key signalling cascades implicated in DKD pathogenesis.