Vitamin D in Diabetic Nephropathy: Today, Tomorrow, Always

Abstract

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin (Type 1 diabetes, T1D). Diabetic nephropathy (DN) is one of the complications of T1D. Diabetic nephropathy is a direct reason for morbidity and mortality in children and adults. Many mechanisms including influence of hyperglycemia (causing hyperfiltration and renal injury), advanced glycation products, and activation of cytokines discussed in development of DN. Nowadays a big attention addressed towards the effects of Vitamin D on DN course. Both animal studies and clinical trials have documented an inverse correlation between low vitamin D levels and DN risk, and supplementation with vitamin D or its active derivatives has been demonstrated to improve DN course. This was as a result of positive effect of vitamin D on endothelial cell injury, reduced proteinuria, attenuated renal fibrosis, direct renoprotective effects of Vitamin D (prevention of the podocytes injury, GBM damage). Additional clinical studies needed to understand deeply the entire network of Vitamin D-dependent changes in diabetic kidneys especially in pediatric patients.