Diabetic nephropathy: recent advances in pathophysiology and challenges in dietary management

BACKGROUND: Diabetic nephropathy (DN) or diabetic kidney disease refers to the deterioration of kidney function seen in chronic type 1 and type 2 diabetes mellitus patients. The progression of the disease is known to occur in a series of stages and is linked to glycemic and blood pressure control. However, despite aggressive blood sugar control the prevalence of chronic kidney disease (CKD) in diabetic patients has not witnessed any decrease in the last two decades; which has lead to identification of additional factors in its progression. The nutritional status of patients is an important and modifiable factor that may influence CKD processes and outcome. It directly stems from the traditional dietary choices that patients make due to poor nutritional awareness. Dietary management of DN patients is challenging, as the twin factors of diet overload on kidney function needs to be balanced with malnutrition. Patient education seems to be the key in avoiding overindulgence of carbohydrate and protein-rich foods while favoring inclusion of essential fats in their diet. CONCLUSION: This review will summarize current advances in staging and molecular pathogenesis of DN. It will highlight recent studies focusing on patient-customized dietary interventions that offer new hope as an effective tool in improving quality of life and delaying disease progression in DN patients.