Epigenetics refers to a heritable change in the pattern of gene expression that 
is mediated by a mechanism specifically not due to alterations in the primary 
nucleotide sequence. Well-known epigenetic mechanisms encompass DNA methylation, 
chromatin remodeling (histone modifications), and RNA interference. 
Functionally, epigenetics provides an extra layer of transcriptional control and 
plays a crucial role in normal physiological development, as well as in 
pathological conditions. Aberrant DNA methylation is implicated in immune 
dysfunction, inflammation, and insulin resistance. Epigenetic changes may be 
responsible for 'metabolic memory' and development of micro- and macrovascular 
complications of diabetes. MicroRNAs are critical in the maintenance of 
glomerular homeostasis and hence RNA interference may be important in the 
progression of renal disease. Recent studies have shown that epigenetic 
modifications orchestrate the epithelial-mesenchymal transition and eventually 
fibrosis of the renal tissue. Oxidative stress, inflammation, 
hyperhomocysteinemia, and uremic toxins could induce epimutations in chronic 
kidney disease. Epigenetic alterations are associated with inflammation and 
cardiovascular disease in patients with chronic kidney disease. Reversible 
nature of the epigenetic changes gives a unique opportunity to halt or even 
reverse the disease process through targeted therapeutic strategies.