Essay: Diabetic nephropathy

Diabetic nephropathy is the primary basis of kidney disease in patients initiating renal replacement therapy and affects ‘40% of type 1 and type 2 diabetic patients(Jorge et al. 2005). In accordance to current WHO status there are around 347 million people globally having diabetes. In 2012 diabetes was the undeviating reason for 1.5 million deaths. Providentially, the alarmimg rate of progression has slowed down, perhaps because of the application of numerous trial in clinical practice that contribute to the timely diagnosis and prevention of diabetic nephropathy, which by this means decreases the development of exsisting renal disease (Jorge et al. 2005). The current incretin-based therapies deal with the formerly unattended call in the patients with diabetic therapeutic by modulating glucose supply. Their pharmacological action is based on gut incretin hormones, hormones which are released from intestine after meal- the glucose-dependent insulinotropic peptide (GIP), and the glucagon like peptide-1 (GLP-1), which appear to be out of order in T2DM and have significant effects on insulin and glucagon secretion(Edite et al. 2004). The GLP-1R and DPP-4(dipeptidyl peptidase-4) are expressed in the kidney in diverse genus. The kidney serves to plays a key role in the excretion of incretin metabolites and most GLP-1R agonists and DPP-4 inhibitors.Thus, particular consideration is necessary when applying incretin-based therapy in renal impairment. Preclinical results suggest direct renoprotective effects of incretin-based therapies in the management of hypertension and other disorders of sodium retention, as well as in diabetic and nondiabetic nephropathy(Websky et al. 2014). The ability of DPP-4 to interact with membrane-bound substrates that implement the nonenzymatic properties by interacting with other membrane proteins/receptors put forward that it may be a newer therapeutic objective in diabetic nephropathy(Usha and Carol, 2014).Further the major consideration is required wether incretin remedy with incretins gets better the endothelial function of the micro- and macrovasculature. Incretins and their analogues have diverse actions at the pancreatic level. After binding to specific receptors on ??-cells, they upregulate the insulin gene transcription and its biosynthesis (Perfetti and Merkel, 2000) and stimulate insulin release in a glucose-dependent way (Drucker et al. 1987) since increase in (pro)insulin production takes place at the translational stage, ??-cell secretory ability and insulin supplies are preserved (Alarcon et al. 2006) .