Novel Therapies and Surgical Techniques to Improve Kidney Health

Dear Colleagues,

Healthy kidneys are important for the efficient regulation of metabolism. They filter blood, maintain fluid homeostasis, and are crucial in the process of removing toxins through urine. Deteriorating renal function and chronic kidney disease are closely associated with cardiovascular morbidity and mortality. Kidney diseases are commonly divided into two major groups based on the duration of the disease, i.e., acute kidney injury (AKI) and chronic kidney disease (CKD). There is an ever-increasing population of patients suffering from both acute and chronic kidney diseases that disrupt this homeostasis.

The current definition for AKI was first established in 2004 with a standardized set of criteria. The primary dimension assessed is the magnitude of serum creatinine elevation (change from baseline to peak creatinine), with an increasing emphasis on the duration of the AKI. Based on this definition, the global incidence rate of acute kidney injury is 23.2%. Importantly, high levels of circulating IL-6 in patients with acute kidney injury are predictive of an increased mortality rate. In this regard, therapies that target the IL-6 cytokine signaling pathway have been studied with many fruitful results.

Chronic kidney disease is a common disorder that is defined by structural or functional abnormalities of the kidney and/or a sustained reduction in the glomerular filtration rate. As a high-risk condition, the global rise in the prevalence of CKD is alarming. Between 1990 and 2010, chronic kidney disease rose in the rankings from twenty-seventh to eighteenth in the list of causes of total number of global deaths, which was the second largest rise in the list. Once again, therapies targeting IL-6 family cytokines have provided promising outcomes.

It has been reported that 70% of all cases of end-stage renal disease are related to central obesity, diabetes, and/or hypertension. As such, separating kidney disease from other conditions such as obesity, diabetes, and hypertension is difficult because they are all entwined. The global prevalence of obesity continues to increase, with over 600 million adults and over 100 million children estimated to be obese worldwide. Obesity causes a number of structural changes in the kidneys, including fewer nephrons and abnormal renal tubular exchange. Of significant concern, a high body mass index (BMI) contributed to approximately 7% of deaths globally in 2015, with cardiovascular disease and diabetes being the two leading causes. Diabetes can result in kidney diseases such as diabetic nephropathy, athero-embolic renal disease, ischemic nephropathy, and interstitial fibrosis. There is also a high prevalence of hypertension amongst the obese population. Kidney disease can also progress the propensity for hypertension to increase the activity of the sympathetic nervous system (SNS) or the renin–angiotensin–aldosterone system (RAAS). Activation of the SNS via afferent signals of sensory renal nerves is an early event in the pathophysiology of kidney disease. Surgical procedures such as renal denervation may be beneficial to prevent neurogenic hypertension and may halt the progression of kidney damage and failure.

This Special Issue aims to concentrate on the numerous therapies and surgical techniques that are currently in use to improve kidney health. We will also consider reviews on interesting hypotheses for future interventions to assist with improving and preventing kidney disease.

Dr. Vance Matthews
Guest Editor

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