Novel Approaches in Chronic Renal Failure without Renal Replacement Therapy: A Review

Abstract

Chronic kidney disease (CKD) is characterized by renal parenchymal damage leading to a reduction in the glomerular filtration rate. The inflammatory response plays a pivotal role in the tissue damage contributing to renal failure. Current therapeutic options encompass dietary control, mineral salt regulation, and management of blood pressure, blood glucose, and fatty acid levels. However, they do not effectively halt the progression of renal damage. This review critically examines novel therapeutic avenues aimed at ameliorating inflammation, mitigating extracellular matrix accumulation, and fostering renal tissue regeneration in the context of CKD. Understanding the mechanisms sustaining a proinflammatory and profibrotic state may offer the potential for targeted pharmacological interventions. This, in turn, could pave the way for combination therapies capable of reversing renal damage in CKD. The non-replacement phase of CKD currently faces a dearth of efficacious therapeutic options. Future directions encompass exploring vaptans as diuretics to inhibit water absorption, investigating antifibrotic agents, antioxidants, and exploring regenerative treatment modalities, such as stem cell therapy and novel probiotics. Moreover, this review identifies pharmaceutical agents capable of mitigating renal parenchymal damage attributed to CKD, targeting molecular-level signaling pathways (TGF-β, Smad, and Nrf2) that predominate in the inflammatory processes of renal fibrogenic cells.

Baicalin Exhibits a Protective Effect against Cisplatin-Induced Cytotoxic Damage in Canine Renal Tubular Epithelial Cells

“…Although the further deterioration of the disease can be controlled in the late stage through symptomatic treatment, it significantly affects the quality of life and lifespan of the dogs [25,26]. Renal failure is often accompanied by immune dysregulation and inflammatory responses in the body [27]. Moreover, longterm antibiotic application can have adverse effects on the health of dogs.…”

Causal relationship between gut microbiota and chronic renal failure: a two-sample Mendelian randomization study

“…The gut and kidney can be interconnected through a Metabolism-dependent pathway and an Immune pathway, forming the “gut-kidney axis” ( Yang et al, 2018 ). With the proposal of the “gut-kidney axis” concept, targeting the gut for treatment may become an emerging potential therapeutic strategy for CRF ( Martínez-Hernández et al, 2023 ). While some observational studies and experiments suggest that the gut microbiota plays a significant role in the development and progression of CRF ( Tian et al, 2022 ), the specific causal relationship between the gut microbiota and CRF remains unclear, and there is inconsistency in the findings of gut microbiota studies among dialysis patients, nondialysis patients, and those undergoing hemodialysis or peritoneal dialysis ( Stadlbauer et al, 2017 ; Hu J. et al, 2020 ).…”

A mendelian randomization study revealing that metabolic syndrome is causally related to renal failure

“…Kidney disease impacts >850 million people worldwide, including acute kidney injuries, CKD, and treated kidney failure characterized by renal insufficiency with a GFR < 15 mL/min/1.73 m 2 ( 6 ). The leading causes of renal disease include arterial hypertension and diabetes mellitus ( 7 ), with other contributing conditions also playing a role such as genetic mutations, renal vasculitis, infectious glomerulonephritis, ureteral obstruction, and autoimmune disorders including Goodpasture’s disease, lupus nephritis, and IgA nephropathy ( 8 , 9 ).…”