Better understanding of events that are mediated and perpetuated by glomerular proteinuria and "activation" of tubular cells by ultrafiltered growth factor cytokines gives potentially rise to several targeted interventions (Fig. 6). Their possible therapeutic utility in DN is merely inferential from experimental observations at present, and there are almost no studies in humans yet that would indicate benefit and/or safety. Nevertheless, some of these therapeutic principles may find their way into the clinic in the future.
Inhibition of the Interstitial Inflammatory Response and Macrophage Activation
One of the initial tubular cell responses to ultrafiltered proteins and growth factors is the basolateral secretion of C-C chemokines (MCP-1, and RANTES), which attract and activate macrophages. The latter are thought to be the primary source for profibrogenic
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