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The standard treatment for DKD is drugs controlling hyperglycemia and high blood pressure. Renin angiotensin aldosterone system blockade and sodium glucose cotransporter 2 (SGLT2) inhibition have yielded promising results in DKD, but many diabetic patients on such treatments nevertheless continue to develop DKD, leading to kidney failure and cardiovascular comorbidities. New therapeutic options are urgently required. We review here the promising therapeutic avenues based on insights into the mechanisms of DKD that have recently emerged, including mineralocorticoid receptor antagonists, SGLT2 inhibitors, glucagon\u2010like peptide\u20101 receptor agonist, endothelin receptor A inhibition, anti\u2010inflammatory agents, autophagy activators and epigenetic remodelling. The involvement of several molecular mechanisms in DKD pathogenesis, together with the genetic and epigenetic variability of this condition, makes it difficult to target this heterogeneous patient population with a single drug. Personalized medicine, taking into account the genetic and mechanistic variability, may therefore improve renal and cardiovascular protection in diabetic patients with DKD.<\/jats:p>","DOI":"10.1111\/dom.13969","type":"journal-article","created":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T05:27:13Z","timestamp":1586323633000},"page":"16-31","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":150,"title":["Pathophysiologic mechanisms in diabetic kidney disease: A focus on current and future therapeutic targets"],"prefix":"10.1111","volume":"22","author":[{"given":"Jonatan","family":"Barrera\u2010Chimal","sequence":"first","affiliation":[{"name":"Laboratorio de Fisiolog\u00eda Cardiovascular y Trasplante Renal, Unidad de Investigaci\u00f3n en Medicina Traslacional, Instituto de Investigaciones Biom\u00e9dicas Universidad Nacional Aut\u00f3noma de M\u00e9xico and Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez  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