Diabetic glomerulopathies

The archetypal nodular lesion as described in conventional diabetic glomerulopathies is considered, in the view of recent research advances, as a sub-endothelial microangiopathy developed on a peculiar filtration-type basement membrane (type IV collagen, proteoglycans) and early associated with podocytic and mesangial phenotypic alterations. The molecular pathways leading to glucose pathogenic effect are plural, their interactions, biochemical switch off and regulation mechanisms involving a cellular glucose "operon" are better understood and would allow in the next future to superimpose other therapeutic targets to the hemodynamics changes induced by different angiotensin blockades, future interacting key-controls for the renal microvascular as well as coronary and cerebrovascular risks.