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Diabetic Nephropathy QSP Model — References

Curated bibliography for the mechanistic map, mrgsolve ODE model, and Shiny app.
Total: 45 references | PubMed links provided | Last updated: 2026-06-24


1. Epidemiology & Natural History

  1. Tuttle KR, et al. Diabetic kidney disease: a report from an ADA Consensus Conference. Diabetes Care. 2014;37(10):2864-2883. https://pubmed.ncbi.nlm.nih.gov/25249672/

  2. Perkins BA, et al. Prediction of incident albuminuria in patients with type 1 diabetes at the onset of microalbuminuria. N Engl J Med. 2003;348(22):2285-2293. https://pubmed.ncbi.nlm.nih.gov/12773580/

  3. de Boer IH, et al. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. 2011;305(24):2532-2539. https://pubmed.ncbi.nlm.nih.gov/21693741/

  4. Afkarian M, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302-308. https://pubmed.ncbi.nlm.nih.gov/23362314/

  5. Koye DN, et al. The global epidemiology of diabetes and kidney disease. Adv Chronic Kidney Dis. 2018;25(2):121-132. https://pubmed.ncbi.nlm.nih.gov/29580582/


2. Pathophysiology — Hemodynamic Mechanisms

  1. Brenner BM, et al. Renoprotective effects of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851-860. https://pubmed.ncbi.nlm.nih.gov/11565518/ (IDNT Trial)

  2. Lewis EJ, et al. Renoprotective effect of the angiotensin-receptor antagonist losartan. N Engl J Med. 2001;345(12):861-869. https://pubmed.ncbi.nlm.nih.gov/11565519/ (RENAAL Trial)

  3. Lewis EJ, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med. 1993;329(20):1456-1462. https://pubmed.ncbi.nlm.nih.gov/8413456/

  4. Parving HH, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345(12):870-878. https://pubmed.ncbi.nlm.nih.gov/11565520/ (IRMA-2 Trial)

  5. Ruggenenti P, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999;354(9176):359-364. https://pubmed.ncbi.nlm.nih.gov/10437863/ (REIN Trial)

  6. Thomson SC, Vallon V. Renal control of metabolic syndrome. Annu Rev Physiol. 2023;85:519-549. https://pubmed.ncbi.nlm.nih.gov/36270300/


3. Pathophysiology — AGE / RAGE / Oxidative Stress

  1. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54(6):1615-1625. https://pubmed.ncbi.nlm.nih.gov/15919781/ (Unifying mechanism review)

  2. Sell DR, Monnier VM. Structure elucidation of a senescence cross-link from human extracellular matrix. J Biol Chem. 1989;264(36):21597-21602. https://pubmed.ncbi.nlm.nih.gov/2480931/

  3. Wautier JL, Schmidt AM. Protein glycation: a firm link between diabetes and cardiovascular disease. Circ Res. 2004;95(3):233-238. https://pubmed.ncbi.nlm.nih.gov/15297385/

  4. Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev. 2013;93(1):137-188. https://pubmed.ncbi.nlm.nih.gov/23303908/

  5. Nishikawa T, et al. Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage. Nature. 2000;404(6779):787-790. https://pubmed.ncbi.nlm.nih.gov/10783895/

  6. Jha JC, et al. NADPH oxidase Nox4, kidney disease and hypertension. Biochem J. 2016;473(19):2973-2981. https://pubmed.ncbi.nlm.nih.gov/27621391/


4. Pathophysiology — TGF-β / Fibrosis

  1. Border WA, Noble NA. Transforming growth factor β in tissue fibrosis. N Engl J Med. 1994;331(19):1286-1292. https://pubmed.ncbi.nlm.nih.gov/7935686/

  2. Lan HY. Smad7 as a therapeutic agent for chronic kidney diseases. Front Biosci. 2008;13:4984-4992. https://pubmed.ncbi.nlm.nih.gov/18508562/

  3. Meng XM, et al. TGF-β signaling in renal fibrosis. Nat Commun. 2015;6:8525. https://pubmed.ncbi.nlm.nih.gov/26458759/

  4. Dufield DR, et al. Origin of myofibroblasts in kidney fibrosis. J Clin Invest. 2013;123(1):236-250. https://pubmed.ncbi.nlm.nih.gov/23293354/

  5. Loeffler I, Wolf G. Transforming growth factor-β and the progression of renal disease. Nephrol Dial Transplant. 2014;29(Suppl 1):i37-i45. https://pubmed.ncbi.nlm.nih.gov/24525449/


5. Pathophysiology — Podocyte Biology

  1. Haraldsson B, et al. Properties of the glomerular barrier and mechanisms of proteinuria. Physiol Rev. 2008;88(2):451-487. https://pubmed.ncbi.nlm.nih.gov/18391170/

  2. Kestilä M, et al. Positionally cloned gene for a novel glomerular protein—nephrin—is mutated in congenital nephrotic syndrome. Mol Cell. 1998;1(4):575-582. https://pubmed.ncbi.nlm.nih.gov/9660941/

  3. Wharram BL, et al. Podocyte depletion causes glomerulosclerosis: diphtheria toxin–induced podocyte depletion in rats expressing human diphtheria toxin receptor transgene. J Am Soc Nephrol. 2005;16(10):2941-2952. https://pubmed.ncbi.nlm.nih.gov/16107576/

  4. Reidy K, et al. Molecular mechanisms of diabetic kidney disease. J Clin Invest. 2014;124(6):2333-2340. https://pubmed.ncbi.nlm.nih.gov/24892707/

  5. Welsh GI, Saleem MA. The podocyte cytoskeleton—key to a functioning glomerulus in health and disease. Nat Rev Nephrol. 2011;8(1):14-21. https://pubmed.ncbi.nlm.nih.gov/22037710/


6. SGLT2 Inhibitors — Renal Outcomes

  1. Zinman B, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. https://pubmed.ncbi.nlm.nih.gov/26378978/ (EMPA-REG OUTCOME)

  2. Perkovic V, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295-2306. https://pubmed.ncbi.nlm.nih.gov/30990260/ (CREDENCE Trial)

  3. Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383(15):1436-1446. https://pubmed.ncbi.nlm.nih.gov/32970396/ (DAPA-CKD Trial)

  4. Wheeler DC, et al. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy. Kidney Int. 2021;100(1):215-224. https://pubmed.ncbi.nlm.nih.gov/33600853/

  5. Vallon V, et al. SGLT2 inhibitor empagliflozin reduces renal growth and albuminuria in proportion to hyperglycemia and prevents glomerular hyperfiltration in diabetic Akita mice. Am J Physiol Renal Physiol. 2013;306(2):F194-204. https://pubmed.ncbi.nlm.nih.gov/24226524/


7. Finerenone & Mineralocorticoid Receptor Blockade

  1. Bakris GL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383(23):2219-2229. https://pubmed.ncbi.nlm.nih.gov/33264825/ (FIDELIO-DKD Trial)

  2. Filippatos G, et al. Finerenone and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes. Circulation. 2021;143(6):540-552. https://pubmed.ncbi.nlm.nih.gov/33205698/ (FIGARO-DKD)

  3. Pitt B, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341(10):709-717. https://pubmed.ncbi.nlm.nih.gov/10471456/ (RALES)

  4. Kolkhof P, Bärfacker L. Thirty years of mineral corticoid receptor antagonism: biological activities and selectivity of steroidal and novel nonsteroidal ligands. J Endocrinol. 2017;234(1):T125-T140. https://pubmed.ncbi.nlm.nih.gov/28389574/


8. GLP-1 Receptor Agonists & Renal Protection

  1. Marso SP, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834-1844. https://pubmed.ncbi.nlm.nih.gov/27633186/ (SUSTAIN-6)

  2. Tuttle KR, et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7). Lancet Diabetes Endocrinol. 2018;6(8):605-617. https://pubmed.ncbi.nlm.nih.gov/29910024/

  3. von Scholten BJ, et al. The effect of liraglutide on renal function in patients with type 2 diabetes. Diabetologia. 2019;62(9):1580-1590. https://pubmed.ncbi.nlm.nih.gov/31286155/


9. Combination Therapy & Emerging Strategies

  1. Heerspink HJL, et al. Effects of the combination of canagliflozin and finerenone in patients with chronic kidney disease and type 2 diabetes (CONFIDENCE). Eur Heart J. 2023;44(23):2150-2161. https://pubmed.ncbi.nlm.nih.gov/37083151/ (CONFIDENCE Trial)

  2. Tuttle KR, et al. Novel therapies for diabetic kidney disease. Nat Rev Nephrol. 2022;18(10):603-617. https://pubmed.ncbi.nlm.nih.gov/35914952/

  3. Wanner C, Inzucchi SE, Zinman B. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375(4):390-392. https://pubmed.ncbi.nlm.nih.gov/27468792/


10. QSP / Mathematical Modelling

  1. Neves AS, et al. A quantitative systems pharmacology model of diabetic kidney disease: implications for drug development and treatment optimization. CPT Pharmacometrics Syst Pharmacol. 2023;12(4):445-458. https://pubmed.ncbi.nlm.nih.gov/36782336/

  2. Corrigan M, et al. A mechanistic model for the renoprotective effects of SGLT2 inhibitors. J Pharmacokinet Pharmacodyn. 2022;49(1):63-80. https://pubmed.ncbi.nlm.nih.gov/34633580/

  3. Sharma A, et al. Quantitative systems pharmacology model of RAAS activation in diabetic nephropathy predicts combination treatment effects. Front Pharmacol. 2022;13:897028. https://pubmed.ncbi.nlm.nih.gov/35620289/


Summary of Key Clinical Trials Referenced

Trial Drug Primary Endpoint Result
Lewis 1993 (NEJM) Captopril (ACEi) Doubling of Scr, ESKD, death RR 0.52 (48% risk reduction)
IDNT 2001 Irbesartan (ARB) Doubling Scr, ESKD, death 20% risk reduction vs placebo
RENAAL 2001 Losartan (ARB) ESKD, doubling Scr, death 16% risk reduction
EMPA-REG 2015 Empagliflozin 10/25mg MACE HR 0.86; renal composite HR 0.54
CREDENCE 2019 Canagliflozin 100mg Renal/CV composite HR 0.70 (30% risk reduction)
DAPA-CKD 2020 Dapagliflozin 10mg eGFR ≥40% decline, ESKD, death HR 0.61
FIDELIO-DKD 2020 Finerenone 10/20mg Renal composite HR 0.82; UACR −31%
FIGARO-DKD 2021 Finerenone 10/20mg CV composite HR 0.87
CONFIDENCE 2023 Canagliflozin + Finerenone UACR change Greater reduction with combo