TY - JOUR T1 - Cellular and molecular aspects of diabetic nephropathy; the role of VEGF-A JO - NefrologĂ­a (English Edition) T2 - AU - Carranza,Katherine AU - Veron,Dolores AU - Cercado,Alicia AU - Bautista,Noemi AU - Pozo,Wilson AU - Tufro,Alda AU - Veron,Delma SN - 20132514 UR - https://revistanefrologia.com/en-cellular-molecular-aspects-diabetic-nephropathy-articulo-X2013251415119105 AB - The prevalence of diabetes mellitus increased in the last century, and it is estimated that 45% of patients have not yet been diagnosed. In South America, diabetes and chronic kidney disease (CKD) prevalence increased, and there is great disparity regarding access to dialysis among these countries. In Ecuador, it is one of the major causes of mortality, mainly in provinces located on the Pacific coast. The main cause of admission to dialysis is diabetic nephropathy (DN). Even when the best therapeutic options for DN are used, the residual risk of proteinuria and end-stage CKD continues to be high. In this review, we describe the magnitude of the issue both worldwide and locally. We analysed relevant molecular and cellular studies, which indicate the crucial significance of glomerular events in DN development and progress and in insulin resistance. We included basic anatomical, pathophysiological and clinical concepts, with special emphasis on the role played by angiogenic factors, such as vascular endothelial growth factor (VEGF-A) and its relationship with the insulin receptor, endothelial nitric oxide synthase (eNOS) and angiopoietins. Throughout the text, we suggest several pathways, which, in our opinion, have therapeutic potential. Going further in the study of VEGF-A and angiopoietins, glomerular VEGF resistance status, the VEGF receptor 2/nephrin ratio, VEGF/receptors of insulin/nephrin ratio, the VEGF/NO-eNOS ratio at glomerular level may provide solutions to the urgent issue of DN worldwide and lead to new treatment alternatives. ER -