The Vicious Cycle Between Lipid Metabolism Disorder and Podocyte Injury in Diabetic Nephropathy

Abstract

Diabetes mellitus (DM) is a common chronic metabolic disease, and diabetic kidney disease (DKD) is one of its major complications. At present, an estimated 589 million people worldwide suffer from diabetes. It is predicted that the number of diabetic patients will rise to 853 million by 2050, among whom 30% to 40% will develop DKD and eventually progress to end-stage renal disease (ESRD). In China, the number of adult diabetic patients aged 20 to 79 reaches 148 million, ranking first globally. DKD has become the second leading cause of ESRD after glomerulonephritis, accounting for 19% of all ESRD cases. Studies have confirmed that dyslipidemia participates in the occurrence and progression of DKD and is closely correlated with DKD. Dysregulated lipid metabolism often leads to dysfunction of specific target organs such as the heart and kidneys. Podocytes are highly differentiated cells attached to the outer side of the glomerular basement membrane (GBM) and are the most vulnerable cells in the glomerulus. Podocytes are sensitive to abnormal lipid accumulation. Excessive intracellular lipid accumulation will trigger podocyte dysfunction, cytoskeleton rearrangement, inflammatory responses and ultimately podocyte death. This paper reviews the mechanisms and interactions of DKD, lipid metabolism disorder and podocyte injury reported in recent years, so as to provide new ideas for the treatment of DKD.