Therefore, novel therapeutic approaches are urgently needed, while a growing body of evidence from human, animal, and in vitro studies indicates that existing drugs, including the urate-lowering agent allopurinol, the anti-TNF agents etanercept, endothelin antagonist avosentan, and the immunomodulating drug abatacept, might be effective in preventing or slowing the progression of diabetic nephropathy to end-stage renal disease by targeting metabolic, inflammatory, and immunological pathways [45–47]. The gene discussed is TNF; the disease is stage 5 chronic kidney disease.