DIABETIC NEPHROPATHY AND DIABETIC FOOT SYNDROME: PATHOGENESIS, CLINICAL RELATIONSHIP AND MODERN APPROACHES TO TREATMENT

Diabetic nephropathy and diabetic foot syndrome are one of the most severe and clinically significant complications of diabetes mellitus, determining the quality of life and life expectancy of patients. Their pathogenesis is formed against the background of chronic hyperglycemia, activation of pro-inflammatory and fibrotic cascades, microcirculation disorders and endothelial dysfunction, which forms common links in the lesion of the renal and peripheral vascular systems. The mutual aggravation of diabetic nephropathy and diabetic foot syndrome is due to the cross-involvement of immune mechanisms, disruption of reparative processes and worsening of the prognosis in the presence of terminal chronic kidney disease. Early detection of early stages of nephropathy, including subclinical albuminuria, as well as assessment of neuroischemic forms of foot lesions, are crucial to prevent complications and optimize management tactics. In recent years, integrative approaches to therapy, including the use of metabolically active and nephroprotective drugs, local immunomodulatory agents, as well as the participation of multidisciplinary teams in comprehensive prevention and treatment, have become of particular importance. The presented review summarizes current information on the pathogenesis, clinical relationship and effective directions of therapy for these complications of diabetes mellitus.