Chronic Kidney Disorder: Exploring New Paths to Kidney Repair

Chronic kidney disease (CKD) progresses silently without any change in kidney function at the initial stage. The kidney is a vital organ of the excretory system that is responsible for waste filtration. The other vital functions include maintaining electrolyte balance, regulating blood pressure, supporting RBC production, and maintaining tissue homeostasis. CKD over a prolonged period gradually affects kidney function.

Current CKD treatment in India intends to manage symptoms and slow down the disease progression. However, consistent low-grade inflammation, oxidative stress, and accumulation of scarred tissue interfere with the introduced treatment efficacy. Researchers and clinicians are widely exploring the regenerative approach in the form of stem cell Treatment for Chronic Kidney Disorder. The intent is to target the underlying cause of kidney cells degeneration at the cellular level. They focus on boosting cellular repair, reducing inflammation, modulating immune response, and regenerating and replacing the damaged or scarred cells. However, restoration of lost kidney function is not yet established in routine clinical care. Understanding the scientific possibilities and considering existing limitations is key in developing new directions in kidney therapeutics. The current article explores the underlying mechanism of kidney damage and considers established CKD treatment and emerging regenerative approaches for effective management. 

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What Happens Inside the Damaged Kidney?

Chronic Kidney Disease Develops with Various Mechanistic Changes. The Underlying Pathological Causes Include:

• Persistent Inflammation: Kidney cell injury releases various inflammatory cytokines. This recruits immune cells that migrate to the injury site
• Oxidative Stress: Increased oxidative stress damages various cellular components, including nucleic acids, proteins, and lipids  
• Tubular & Microvascular Injury: The disruption of the vascular system limits oxygen delivery and waste processing. The progressive injury damages the renal tubular cells
• Extracellular Matrix Accumulation: The recruitment of the immune cells activates fibroblasts and myofibroblasts. This leads to excessive production of collagen and other ECM components. It replaces functional tissue with scarred tissues
• Fibrosis: Maladaptive repair mediated by immune response (TGF-β pathway) invokes matrix deposition and progressive renal scarring

What are the CKD Treatments Available in India?

There is no established cure for chronic kidney Disorder. The current CKD Treatment in India focuses on symptom management and improves patients’ quality of life. The key treatments include:

Medication

• Angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB) for blood pressure management
• Phosphate binder to eliminate excessive phosphate
• Diuretics to eliminate excessive fluid from the body
• Erythropoietin to boost RBC formation
• Vitamin D and calcitriol for prevention of bone loss

Lifestyle Intervention

• Comorbid factor management (diabetes, hypertension, hyperlipidemia)
• Dietary intervention (kidney-friendly dietary intake). For eg: limited protein intake, foods with low glycemic or lipid content, limit sodium and potassium intake
• Lifestyle changes like quitting smoking, regular physical activity, maintaining a healthy weight

Dialysis

• Removes the waste products artificially
• Hemodialysis, a form of dialysis where blood is circulated with the help of a machine. It removes waste products, excess salt, or water. The fresh blood is returned to the body
• Peritoneal dialysis is the procedure where dialysis solution is directly placed in the patient’s abdomen. The solution absorbs the waste materials and removes them with the help of a catheter. Clinicians add fresh solution during the next procedure
• Dialysis is recommended when the kidney is significantly damaged and has compromised function

Kidney Transplantation

• Recommended during end-stage kidney disease
• Donor kidney comes either from living donors or deceased donors
• On average, transplantation has a waiting time of 3-5 years in India

*NOTE: The current CKD treatment in India focuses on improving the symptoms and slowing down the disease progression. However, they do not reverse the underlying cause. This has aroused researchers’ and clinicians’ interest in exploring advanced regenerative solutions.  

Where Does Regenerative Research Stand?

Regenerative medicine is evolving globally at a rapid pace. Stem cell research for CKD involves a regenerative approach to addressing kidney failure. Researchers are widely exploring mesenchymal stem cells (MSCs) to target CKD. The key advantages include: (i) ability to differentiate into distinct cell types; (ii) paracrine signalling. Stem cell treatment for Chronic Kidney Disease involves various mechanisms, including:

Kidney Cell Regeneration and Repair

• MSCs differentiate into distinct cell types based on the stimulation
• Different cell types include podocytes, tubular cells, glomerular endothelial cells, loop of Henle cells, etc.
• MSCs release various signalling molecules that boost the body’s natural repair mechanism

Anti-Inflammation and Immunomodulation

• MSCs release various anti-inflammatory cytokines; they combat the action of pro-inflammatory cytokines
• Modulates immune response; they reduce the risk of immune-mediated kidney damage
• Combats scarred tissue disposition (fibrosis)

Paracrine Effect

• MSCs release various growth factors and cytokines
• They boost tissue repair, manage cellular communication, and improve kidney function
• Replacement of dead or scarred tissue. MSCs creates a healthier microenvironment, and supports existing nephrons

Angiogenesis

• MSCs release various growth factors and cytokines (FGF, VEGF) that boost tiny blood vessel formation
• Boosts supply of blood, nutrients, and oxygen delivery at the damaged tissue site
• Supports tissue homeostasis and survival of surrounding tissues

From Biological Mechanisms to Clinical Evidence: Where Does Research Stand?

Preclinical and early clinical research have set a positive trend in improving renal function. The key stem cell therapy for kidney disorders in India and globally reported:

• Slowed disease progression and improved clinical outcomes in comparison with conventional treatment alone
• Stabilized renal function and reduced instances of fibrosis
• Lower inflammation and reduced pain
• Combination of stem cell treatment for kidney disease in India and kidney transplantation showed reduced instances of acute rejection and improvement in long-term graft survival
• MSCs facilitate management of co-morbid conditions like diabetes, oxidative stress, hypertension, etc. [1]

*NOTE: The outcome of the stem cell therapy for CKD in India and globally varies among individuals. Stem cell source, quality, isolation procedure, delivery method, and individual’s health status affect the clinical outcome. In fact, patients at the early to moderate stage of chronic kidney Disorder showed better effects. Advancells, India, is a leading manufacturer and supplier of clinical-grade stem cells for several chronic health conditions, including chronic kidney Disorder. The cell is accompanied by a Certificate of Authentication (CoA).

Conclusion

Chronic kidney disease is progressive, and kidney function declines with time. It is crucial to note the earliest symptoms to combat further degeneration. Current CKD treatment in India focuses on medication, modification of lifestyle factors, dialysis, and kidney transplantation. The introduced treatment regimen depends on the disease stage and severity.  Stem Cell Treatment for Chronic Kidney Disease is evolving at a rapid pace. Clinicians are introducing a combination of conventional treatment with a regenerative approach for better treatment outcomes.  Future researchers focus on launching large-scale clinical trials to establish long-term safety and efficacy.

References

1. Allinson CS, Pollock CA, Chen X. Mesenchymal stem cells in the treatment of acute kidney injury (AKI), chronic kidney disease (CKD) and the AKI-to-CKD transition. Integrative Medicine in Nephrology and Andrology. 2023 Mar 1;10(1):e00014. 

FAQ’s

Q- How is CKD treated in India?

CKD treatment in India focuses on targeting symptoms and slowing disease progression. Current treatment regimen involves medication, dialysis, and managing co-morbid conditions (diabetes, hypertension, hyperlipidemia). Clinicians recommend treatments based on the stage and severity of the disease.

Q- Can stem cell treatment for CKD restore kidney function?

Stem cell treatment for Chronic Kidney Disorder targets the underlying cause of the problem. This includes boosting repair mechanisms, targeting inflammation, protecting surviving kidney cells, immunomodulation, etc. 

Q- Is stem cell therapy for CKD in India an established treatment option?

No, stem cell therapy for CKD in India and globally is investigational. Clinicians recommend stem cell introduction as a supportive approach along with established stem cell therapy. Anyone considering such an approach should consult a qualified nephrologist and verify the clinical evidence. 

Q- What factors influence the choice of CKD treatment in India?

CKD treatment in India considers the underlying cause, stage, and disease severity. The suitability of the treatment depends on the individual’s factors. Evidence-based kidney care remains an essential part of CKD treatment. Currently, with growing evidence of regenerative medicine, clinicians are recommending stem cell therapy as a supportive option.