Diabetic kidney disease is growing exponentially. This review aims to discuss alternate therapeutic approaches beyond the glomerulocentric view and to consider a novel tubulocentric approach with focus on the primary cilia. Renin–angiotensin-aldosterone system blockade to decrease glomerular capillary pressure and prevent albuminuria has been the mainstay of treatment for diabetic and non-diabetic proteinuric kidney disease. Landmark clinical trials have also shown cardiorenal benefit with sodium-glucose linked co-transporter 2 inhibitors and glucagon-like peptide 1 receptor analogues in patients with type 2 diabetes. Effective renoprotective drugs seem to have a common mechanistic mode of reducing glomerular hyperfiltration/hypertension. In the tubules, primary cilia act as “antennae” to detect mechanosensory changes such as glomerular hyperfiltration and trgger intracellular signalling pathways. They are also implicated in obesity and metabolic disorders linked to diabetes. To conclude, primary cilia of the kidney tubules offer a novel therapeutic target and may complement the current glomerulocentric approaches.

糖尿病肾病呈指数增长。这篇综述旨在讨论肾小球中心视野以外的其他治疗方法，并考虑以原发纤毛为重点的新型肾小管中心治疗方法。肾素-血管紧张素-醛固酮系统阻滞降低肾小球毛细血管压并防止蛋白尿已成为糖尿病和非糖尿病性蛋白尿肾病的主要治疗手段。具有里程碑意义的临床试验还显示，钠糖连接的共转运蛋白2抑制剂和胰高血糖素样肽1受体类似物对2型糖尿病患者的心脏肾脏有益。有效的肾脏保护药物似乎具有减少肾小球高滤过/高血压的常见机制。在肾小管 初级纤毛充当“天线”，以检测机械感觉变化，例如肾小球超滤和触发细胞内信号传导途径。它们还涉及与糖尿病有关的肥胖和代谢紊乱。总而言之，肾小管的初级纤毛提供了新的治疗靶点，并且可以补充当前的肾小球中心点治疗方法。