Research Progress on the Pathogenesis and Chinese and Western Medicine Treatment of Diabetic Kidney Disease

Abstract

Diabetic kidney disease (DKD) is a common microvascular complication of diabetes and an important cause of chronic kidney disease progressing to kidney failure. Its onset and progression are not attributable to hyperglycemia alone, but rather to the combined effects of multiple factors, including disorders of glucose and lipid metabolism, abnormal glomerular hemodynamics, oxidative stress, inflammatory responses, impaired autophagy, programmed cell death, and renal fibrosis. Modern medical treatment has evolved from simply controlling blood glucose and blood pressure to comprehensive interventions aimed at reducing proteinuria and providing cardiorenal protection. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, renin-angiotensin-aldosterone system (RAAS) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists play important roles in slowing disease progression. In traditional Chinese medicine (TCM), DKD is considered a disorder characterized by deficiency in the root and excess in the branch, with qi-yin deficiency and spleen-kidney deficiency as the root and dampness, blood stasis, phlegm, turbidity, and toxin as the manifestations of excess. Chinese herbal formulas, proprietary Chinese medicines, and herb pairs may ameliorate renal injury through multitarget regulation. This review summarizes the major pathogenic mechanisms of DKD and advances in Western and Chinese medical treatment, with the aim of providing a reference for clinical prevention and management.