Researchers have made a discovery that could see patients with kidney disease no longer having to resort to dialysis or kidney transplants.

Chronic kidney disease (CKD) can be caused by a number of factors, and results in permanent, irreversible scarring of the kidney leading to end-stage renal disease (ESRD). Once a patient has reached this point their only option is dialysis or transplantation.

Research led by Monash University scientists has shown for the first time the effectiveness of combining a stem cell-based therapy with an anti-scarring agent to reverse scarring and markers of kidney injury, reducing the need for dialysis or transplantation.

Associate Professor Sharon Ricardo, Department of Anatomy and Developmental Biology, said the researchers had discovered that adult stem cells, combined with a protein called serelaxin, could reverse scarring.

“Adult stem cells have proved promising for the treatment of a wide range of diseases, including kidney disease,” she said.

“We decided to investigate how adult stem cells could help reduce the scarring effect. We demonstrated that adult stem cells and serelaxin on their own have a limited effect on reversing kidney scarring, yet when used in combination with serelaxin can provide significant protection from kidney damage.”

Associate Professor Ricardo said the adult cells did not turn into kidney cells, rather they help the injured kidney repair itself.

"However, the potential of these stem cells is reduced in patients who have a lot of scarring due to the disease.”

Associate Professor Chrishan Samuel, Department of Pharmacology, said serelaxin was currently undergoing phase III clinical trials to assess its ability to treat symptoms and end-stage mortality in patients with acute heart failure.

“We believe that by reducing the scarring associated with chronic kidney disease, serelaxin creates an improved environment for the administration of stem cells, and can directly improve the viability and therapeutic efficacy of introduced stem cells,” he said.

PhD candidate Brooke Huuskes, Department of Anatomy and Developmental Biology, said the finding was important as kidney disease was increasing worldwide placing huge economic burden on health care systems.

“There is no cure for kidney disease, and alarmingly three out of four people on dialysis will die waiting for a kidney transplant, and even those who are lucky enough to receive a transplant often end up back on dialysis due to rejection or graft failure,” she said.

Brooke, who had a kidney transplant in 2010, said it meant a lot to her to be able to do research into something that was very personal to her and that she was passionate about.

Source: Monash University

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A number of kidney patients experience hardship because many government bodies refuse to employ them. This is a further problem in addition to those involving the long waiting list for kidney transplants.
The patients said dialysis centers were far away and too few to serve the large number of patients. There seems to be no clear program by the Health Ministry aimed at reducing the number of patients through proper education and early diagnosis of the problems.
Mohammad Al-Hassan suffered kidney failure in 2009, and from then up to the present, he has not been able to find a job that will help him provide for his family.
“In the beginning, I suffered from symptoms such as vomiting and pain in my joints,” he told a local newspaper.
“When I went to hospital, the specialist told me there were salts in my body which were causing kidney failure. I was referred to a hospital in Al-Ahsa in order to undergo dialysis,” he said.
After that, whenever he applied for a job, he was rejected because of kidney failure and a lack of assistance from the government.
Mohammad Al-Abdi said he had had kidney problems since birth but that he had learned to live with them. He continues to hope for a kidney donor who will help him end his suffering.
Mahdi Al-Ajmi complained of the difficulty in dealing with medical staff responsible for dialysis; he undergoes dialysis several times during the week.
Mansoor Al-Darea had to undergo dialysis three times a week. The dialysis center was a long way from his home and so he borrowed money and went to Egypt where he had a kidney transplant.
Umm Abdullah, a divorcee, said her son, aged 14, had had kidney failure since he was 4. His treatment is in Al-Qatif hospital which means they have to travel 200 km three days a week for dialysis.
Waheed Abdul Bashir said he has been undergoing dialysis three times a week for six years now.
“Kidney failure makes you lose everything; not just your health, you end up losing your job, with no one to help you but the social security which is less than SR3,000 a month,” he added.
Mohammad Abdo Asiri started dialysis over two years ago and hopes to find a donor who will end his suffering.

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Even women with mild, stage 1 chronic kidney disease (CKD) have increased risks of adverse pregnancy outcomes, a new Italian study confirms. The findings might improve prenatal counseling and monitoring practices of women with CKD during pregnancy.

“The findings indicate that any kidney disease—even the least severe, such as a kidney scar from a previous episode of kidney infection, with normal kidney function—has to be regarded as relevant in pregnancy, and all patients should undergo a particularly careful follow-up,” lead researcher Giorgina Barbara Piccoli, MD, of the University of Torino in Italy, said in a news release. “Conversely, we also found that a good outcome was possible in patients with advanced CKD, who are often discouraged to pursue pregnancy.”

For the study, the investigators compared pregnancy outcomes in 504 women with CKD and 836 women without CKD, hypertension, diabetes, obesity, cardiovascular disease, or any other severe disease that might affect pregnancy. The women were participants in 2 separate cohorts from the Torino-Cagliari Observational Study (TOCOS), which assessed pregnancy outcomes prospectively for periods between 2000 and 2013.

The risk of adverse pregnancy outcomes increased with CKD stage, according to results published online ahead of print in the Journal of the American Society of Nephrology. The combined risk of pre-term delivery, need for care in the neonatal intensive care unit, and small infant size for gestational age was 34% for women with stage 1 CKD compared with 90% for women with stages 4 to 5. Similarly, the risk of severe cases of the above was 21% in stage 1 patients compared with 80% in patients with stages 4 to 5.

Classic risk factors could not fully explain the excess risks associated with CKD. Women with stage 1 CKD who gave birth prematurely were 3.1 to 3.7 times more likely to have hypertension, proteinuria, or systemic disease (such as diabetic nephropathy, lupus, collagen diseases, vasculitides, or kidney transplant). However, women with stage 1 CKD without these extra conditions still had almost twice the risk of adverse pregnancy-related outcomes. Notably, the risk of intrauterine death was similar between CKD patients and controls.

“By definition, patients with stage 1 CKD have normal kidney function; therefore, the significant differences compared with the low-risk control population demonstrate that kidney function impairment is not the only element to be taken into consideration for risk assessment in CKD pregnancy,” the researchers stated.

They recommend a prediction model, similar to that developed for preeclampsia, to help identify patients at higher risk.

1. Piccoli, GB, et al. Journal of the American Society of Nephrology, 2015; doi: 10.1681/ASN.2014050459.
   
2. American Society of Nephrology news release, March 12, 2015.

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