Improving Kidney Disease Care: One Giant Leap for Nephrology

Abstract

Nephrology is an ever-evolving field of medicine. The importance of such a discipline is related to the high clinical impact of kidney disease. In fact, abnormalities of kidney function and/or structure are common in the general population, reaching an overall prevalence of about 10%. More importantly, the onset of kidney damage is related to a strikingly high risk of cardiovascular events, mortality, and progression to kidney failure which, in turn, compromises quality and duration of life. Attempts to comprehend the pathogenesis and molecular mechanisms involved in kidney disease occurrence have prompted the development and implementation of novel drugs in clinical practice with the aim of treating the 'specific cause' of kidney disease (including chronic kidney disease, glomerular disease, and genetic kidney disorders) and the main immunological complications following kidney transplantation. Herein, we provide an overview of the principal emerging drug classes with proved efficacy in the context of the aforementioned clinical conditions. This can represent a simplified guide for clinical nephrologists to remind them of the vast and heterogeneous armamentarium of drugs that should be used in the present and the future to improve the management of patients suffering from kidney disease.

Keywords: CKD; ESKD; albuminuria; prognosis; target therapy; transplant immunology.

Figure 1

Overview of the available treatments of kidney disease. APRIL, a proliferation inducing ligand; CKD, chronic kidney disease; ET1-AT1, endothelin 1—angiotensin II receptor type 1; GLP1, glucagon-like peptide 2; HIF, hypoxia-inducible factor; MRA, mineralocorticoid receptor antagonist; RNA, ribonucleic acid; SGLT2, sodium-glucose cotransporter 2.