Novel strategies in nephrology: what to expect from the future?

Abstract

Chronic kidney disease (CKD) will become the fifth global case of death by 2040. Its largest impact is on premature mortality but the number of persons with kidney failure requiring renal replacement therapy (RRT) is also increasing dramatically. Current RRT is suboptimal due to the shortage of kidney donors and dismal outcomes associated with both hemodialysis and peritoneal dialysis. Kidney care needs a revolution. In this review, we provide an update on emerging knowledge and technologies that will allow an earlier diagnosis of CKD, addressing the current so-called blind spot (e.g. imaging and biomarkers), and improve renal replacement therapies (wearable artificial kidneys, xenotransplantation, stem cell-derived therapies, bioengineered and bio-artificial kidneys).

Keywords: artificial kidney; bioengineering; chronic kidney disease; induced pluripotent stem cells; xenotransplantation.

Figure 1:

General overview of the novel strategies in nephrology. (Diagnostics will be further elaborated in detail in Fig. 2.)

Figure 2:

Novel diagnostic methods in nephrology. CFE-MRI: cationized ferritin-enhanced MRI; RadioCF-PET: radiolabeled cationic ferritin-positron emission tomography; CKD: chronic kidney disease; AKI: acute kidney injury; GBM: glomerular basement membrane; KRIS: Kidney Risk Inflammatory Signature; THSD7A: thrombospondin type-1 domain–containing 7A antibodies; NAD: nicotinamide adenine dinucleotide; FAT1: glomerular antigen-protocadherin FAT1; ESRD: end-stage renal disease; DKD: diabetic kidney disease; HST: hematopoietic stem cell transplantation; PCX: podocalyxin; KIM-1: kidney injury molecule 1; TNF-α: tumor necrosis factor-α; 8-OHdG: 8-oxo-7,8-dihydro- 2′-deoxyguanosine; L-FABP: liver-type fatty acid binding protein; IGFBP-7: insulin-like growth factor-binding protein-7; TIMP-2: tissue inhibitor of metalloprotease-2; DIKI: drug-induced kidney injury; CNA35-CT: collagen-binding adhesion protein-35 CT; ESMA-based MRI: elastin-specific contrast agent MRI; DW-MRI: diffusion-weighted MRI; BOLD-MRI: blood oxygen level–dependent MRI; HP-13C MRI: hyperpolarized carbon 13 MRI; plus sign: advantages; minus sign: disadvantages/limitations (indicated in red color).

Figure 3:

Novel therapeutic alternatives in nephrology. G-CSF: granulocyte colony stimulating factor. plus sign: advantages; minus sign: disadvantages/limitations (indicated in red color).