New Herbal Approaches for the Treatment of Diabetic Kidney Diseases and Its Therapeutic Implications

Epidemiology

The recent steep rise in the prevalence of metabolic syndrome and of Type 2 diabetes worldwide is extremely pronounced in Asian nations and is particularly dramatically increasing in India. This gave India the dubious distinction of the “diabetes capital of the world”. In urban Indians, the overt nephropathy and microalbuminuria was found to be 2.2 and 26.9%, respectively (Ritz & Zeng, 2011). Diabetic kidney diseases are the most common causes of chronic kidney failure and end-stage kidney diseases in the United States (Mehdi & Toto, 2009).

Factors responsible for intraglomerular hypertension include activation of various vasoactive systems, such as endothelial systems and the RAAS. Polyol pathway, oxidative stress, inflammation and PKC pathways which are involved in making it a syndrome; with serious complications. These changes results to high secretion of fibrotic cytokines such as transforming growth factor β resulting to furtherance of haemodynamic changes (Sharma & Sharma,2013). The earliest clinical evidence of nephropathy is an increase in microalbuminuria (defined as >30 mg/day) into the macroalbuminuria range (>300 mg/day) (Toth-Manikowski &Atta, 2015). Renal function is compromised even prior to the onset of initial damage to the kidney. There occurs several oxidation and reduction changes that appears early and continue as chronic damage progresses, highlighting the complexities of the disease. Besides the classical anti-diabetic drugs such as sulfonyl urea, begonides, α- glucosidase inhibitors, PPAR-γ agonists (Peroxisome proliferator activated receptor), Sodium dependent glucose co-transport (SGLT-2) inhibitors, aldose reductase inhibitors, DPP-IV (Dipeptidyl peptidase-4) inhibitors etc are being developed to manage hyper-glycemia (Pathak and Bridgeman, 2010).