Macrophages in Focus: Key Drivers and Therapeutic Opportunities in Diabetic Kidney Disease

Diabetic kidney disease (DKD), a common microvascular complication of diabetes, has emerged as the leading cause of end-stage renal disease (ESRD), with its prevalence increasing annually, thereby constituting a global epidemiological crisis. Despite this, the search for effective therapeutic strategies remains challenging, underscoring the urgent need for innovative treatments. In recent years, numerous studies have highlighted the role of inflammation in DKD progression, with fibrosis serving as a critical mechanism driving DKD towards ESRD. Intervening in these core processes may reveal new avenues for the etiology and management of DKD. Macrophages, immune cells derived from monocytes, possess phagocytic and digestive functions and play integral roles in tissue and organ development, homeostasis, as well as tissue repair and regeneration. Emerging research suggests that macrophages are crucial in DKD progression and renal injury, thus attracting significant academic attention. This review highlights the role and mechanisms of macrophages in the inflammatory and fibrotic processes in DKD. It also explores current therapeutic approaches targeting macrophages. In light of recent research, we propose that macrophages-focused interventions present a promising therapeutic avenue for DKD.