Reactive oxygen species and diabetic nephropathy

Diabetic nephropathy remains a major microvascular complication of diabetes and the most common cause of end-stage renal disease requiring dialysis in the USA. Medical advances over the past century have substantially improved the management of diabetes mellitus and thereby increased patient survival. However, current standards of care reduce but do not eliminate the risk of diabetic nephropathy, and future studies are required to further understand the molecular mechanisms involved in the pathogenesis of diabetic nephropathy. There is an increasing body of evidence indicating that reactive oxygen species (ROS) may play a major role in the development of diabetic nephropathy. Oxidative stress is increased in diabetes, and the overproduction of ROS correlates with complications of diabetes, including diabetic nephropathy. Both NADPH oxidase and mitochondrial electron gradients seem to play critical roles in hyperglycemia-induced ROS generation. However, the key pathways by which hyperglycemia leads to enhanced ROS and structural changes associated with diabetic nephropathy are not well established. It is known that in addition to their ability to directly inflict macromolecular damage, ROS can function as signaling molecules resulting in transcriptional activation of profibrotic genes in the kidney. Here, we highlight the role of ROS in the development of the diabetic kidney disease. In particular, we will discuss recent advances in our understanding of the molecular mechanisms by which mitochondrial ROS might be implicated in the pathogenesis and progression of diabetic nephropathy.