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Chronic Kidney Allograft Disease: New Concepts and Opportunities

Chronic kidney disease (CKD) is increasing in most countries and kidney transplantation is the best option for those patients requiring renal replacement therapy. Therefore, there is a significant number of patients living with a functioning kidney allograft. However, progressive kidney allograft fu...

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Autores principales: Codina, Sergi, Manonelles, Anna, Tormo, Maria, Sola, Anna, Cruzado, Josep M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316649/
https://www.ncbi.nlm.nih.gov/pubmed/34336878
http://dx.doi.org/10.3389/fmed.2021.660334
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author Codina, Sergi
Manonelles, Anna
Tormo, Maria
Sola, Anna
Cruzado, Josep M.
author_facet Codina, Sergi
Manonelles, Anna
Tormo, Maria
Sola, Anna
Cruzado, Josep M.
author_sort Codina, Sergi
collection PubMed
description Chronic kidney disease (CKD) is increasing in most countries and kidney transplantation is the best option for those patients requiring renal replacement therapy. Therefore, there is a significant number of patients living with a functioning kidney allograft. However, progressive kidney allograft functional deterioration remains unchanged despite of major advances in the field. After the first post-transplant year, it has been estimated that this chronic allograft damage may cause a 5% graft loss per year. Most studies focused on mechanisms of kidney graft damage, especially on ischemia-reperfusion injury, alloimmunity, nephrotoxicity, infection and disease recurrence. Thus, therapeutic interventions focus on those modifiable factors associated with chronic kidney allograft disease (CKaD). There are strategies to reduce ischemia-reperfusion injury, to improve the immunologic risk stratification and monitoring, to reduce calcineurin-inhibitor exposure and to identify recurrence of primary renal disease early. On the other hand, control of risk factors for chronic disease progression are particularly relevant as kidney transplantation is inherently associated with renal mass reduction. However, despite progress in pathophysiology and interventions, clinical advances in terms of long-term kidney allograft survival have been subtle. New approaches are needed and probably a holistic view can help. Chronic kidney allograft deterioration is probably the consequence of damage from various etiologies but can be attenuated by kidney repair mechanisms. Thus, besides immunological and other mechanisms of damage, the intrinsic repair kidney graft capacity should be considered to generate new hypothesis and potential therapeutic targets. In this review, the critical risk factors that define CKaD will be discussed but also how the renal mechanisms of regeneration could contribute to a change chronic kidney allograft disease paradigm.
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spelling pubmed-83166492021-07-29 Chronic Kidney Allograft Disease: New Concepts and Opportunities Codina, Sergi Manonelles, Anna Tormo, Maria Sola, Anna Cruzado, Josep M. Front Med (Lausanne) Medicine Chronic kidney disease (CKD) is increasing in most countries and kidney transplantation is the best option for those patients requiring renal replacement therapy. Therefore, there is a significant number of patients living with a functioning kidney allograft. However, progressive kidney allograft functional deterioration remains unchanged despite of major advances in the field. After the first post-transplant year, it has been estimated that this chronic allograft damage may cause a 5% graft loss per year. Most studies focused on mechanisms of kidney graft damage, especially on ischemia-reperfusion injury, alloimmunity, nephrotoxicity, infection and disease recurrence. Thus, therapeutic interventions focus on those modifiable factors associated with chronic kidney allograft disease (CKaD). There are strategies to reduce ischemia-reperfusion injury, to improve the immunologic risk stratification and monitoring, to reduce calcineurin-inhibitor exposure and to identify recurrence of primary renal disease early. On the other hand, control of risk factors for chronic disease progression are particularly relevant as kidney transplantation is inherently associated with renal mass reduction. However, despite progress in pathophysiology and interventions, clinical advances in terms of long-term kidney allograft survival have been subtle. New approaches are needed and probably a holistic view can help. Chronic kidney allograft deterioration is probably the consequence of damage from various etiologies but can be attenuated by kidney repair mechanisms. Thus, besides immunological and other mechanisms of damage, the intrinsic repair kidney graft capacity should be considered to generate new hypothesis and potential therapeutic targets. In this review, the critical risk factors that define CKaD will be discussed but also how the renal mechanisms of regeneration could contribute to a change chronic kidney allograft disease paradigm. Frontiers Media S.A. 2021-07-14 /pmc/articles/PMC8316649/ /pubmed/34336878 http://dx.doi.org/10.3389/fmed.2021.660334 Text en Copyright © 2021 Codina, Manonelles, Tormo, Sola and Cruzado. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Codina, Sergi
Manonelles, Anna
Tormo, Maria
Sola, Anna
Cruzado, Josep M.
Chronic Kidney Allograft Disease: New Concepts and Opportunities
title Chronic Kidney Allograft Disease: New Concepts and Opportunities
title_full Chronic Kidney Allograft Disease: New Concepts and Opportunities
title_fullStr Chronic Kidney Allograft Disease: New Concepts and Opportunities
title_full_unstemmed Chronic Kidney Allograft Disease: New Concepts and Opportunities
title_short Chronic Kidney Allograft Disease: New Concepts and Opportunities
title_sort chronic kidney allograft disease: new concepts and opportunities
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316649/
https://www.ncbi.nlm.nih.gov/pubmed/34336878
http://dx.doi.org/10.3389/fmed.2021.660334
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