Diabetic nephropathy: landmark clinical trials and tribulations

Diabetic nephropathy remains the most common cause of end-stage renal disease worldwide. The current standard of therapy for diabetic nephropathy involves stringent blood pressure control via blockade of the renin–angiotensin system and control of hyperglycemia. Despite these strategies, diabetic nephropathy is still seen to progress relentlessly. A pressing need for novel therapeutic agents has fueled endless basic science research projects and clinical trials in the quest for a more specific therapy. Throughout the process, only a handful of ancillary agents have shown experimental promise and even fewer have demonstrated an impact in human trials. This review article aims to summarize the available data from landmark studies for the main therapeutic approaches investigated.