Background: Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are associated with future renal microvascular complication (diabetic nephropathy) following poor glycemic control, as defined by glycosylated hemoglobin or hemoglobin A1C (HbA1c) level of >7.5%. Diabetic nephropathy commences with microalbuminuria which may progress to macroalbuminuria. The latter signals the onset of overt diabetic kidney disease (DKD) which is a leading cause of mortality among diabetic patients, as well as end-stage kidney disease (ESKD) worldwide. Current renoprotective interventions may retard the progression of DKD to ESKD

Aim: This review aims to examine the usefulness of the current conventional and novel methods of reno-protection in retarding the progression of DKD to ESKD

Literature search strategy: Using appropriate descriptors, the PubMed database was searched for relevant original articles published within the past 20 years.

Major findings: Whereas conventional renoprotective interventions target specific modifiable DKD risk factors, the novel interventions act at the specific stages of the pathogenic pathways of DKD. Conventional methods of renoprotection like strict glycemic control, control of hypertension, treatment of dyslipidemia and lifestyle modifications appear as effective as novel drugs like uric acid antagonist, vitamin D analogues, endothelin receptor antagonists, and glucose-lowering agents in retarding the progression of DKD. However, some of these novel therapeutic agents are still undergoing trials in human subjects to validate their efficacy.

Conclusion: Conventional and novel renoprotective strategies in DKD are useful in slowing disease progression to ESKD. More research is still needed to establish the effectiveness of some novel drugs in DKD.

Keywords: Diabetic kidney disease, End-stage kidney disease, Microalbuminuria, Macroalbuminuria, Renoprotection, Risk factors.