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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Detalhes bibliográficos
Autores: Codina, Sergi, Manonelles, Anna, Tormo, Maria, Sola Martínez, Anna, Cruzado, Josep Ma.
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/179832
Acesso em linha:https://hdl.handle.net/2445/179832
Access Level:acceso abierto
Palavra-chave:Trasplantament renal
Insuficiència renal crònica
Kidney transplantation
Chronic renal failure
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spelling Chronic Kidney Allograft Disease: New Concepts and OpportunitiesCodina, SergiManonelles, AnnaTormo, MariaSola Martínez, AnnaCruzado, Josep Ma.Trasplantament renalInsuficiència renal crònicaKidney transplantationChronic renal failureChronic 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 SA2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/179832Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.3389/fmed.2021.660334Frontiers in Medicine, 2021, vol. 8, num. 660334https://doi.org/10.3389/fmed.2021.660334cc by (c) Codina, Sergi et al., 2021http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1798322026-05-27T06:46:51Z
dc.title.none.fl_str_mv Chronic Kidney Allograft Disease: New Concepts and Opportunities
title Chronic Kidney Allograft Disease: New Concepts and Opportunities
spellingShingle Chronic Kidney Allograft Disease: New Concepts and Opportunities
Codina, Sergi
Trasplantament renal
Insuficiència renal crònica
Kidney transplantation
Chronic renal failure
title_short 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_sort Chronic Kidney Allograft Disease: New Concepts and Opportunities
dc.creator.none.fl_str_mv Codina, Sergi
Manonelles, Anna
Tormo, Maria
Sola Martínez, Anna
Cruzado, Josep Ma.
author Codina, Sergi
author_facet Codina, Sergi
Manonelles, Anna
Tormo, Maria
Sola Martínez, Anna
Cruzado, Josep Ma.
author_role author
author2 Manonelles, Anna
Tormo, Maria
Sola Martínez, Anna
Cruzado, Josep Ma.
author2_role author
author
author
author
dc.subject.none.fl_str_mv Trasplantament renal
Insuficiència renal crònica
Kidney transplantation
Chronic renal failure
topic Trasplantament renal
Insuficiència renal crònica
Kidney transplantation
Chronic renal failure
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.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/179832
url https://hdl.handle.net/2445/179832
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3389/fmed.2021.660334
Frontiers in Medicine, 2021, vol. 8, num. 660334
https://doi.org/10.3389/fmed.2021.660334
dc.rights.none.fl_str_mv cc by (c) Codina, Sergi et al., 2021
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Codina, Sergi et al., 2021
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Frontiers Media SA
publisher.none.fl_str_mv Frontiers Media SA
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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