期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 80, 期 2, 页码 251-263出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2021.11.010
关键词
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资金
- Instituto de Salud Carlos III (ISCIII) [PI17/00119, PI20/00140, DTS20/00083, PI18/01366, PI19/00588, PI19/00815, DTS18/00032, RD16/0009, RICORS2040 RD21/0005/0001]
- Fondos FEDER European Union [PI17/00119, PI20/00140, DTS20/00083, PI18/01366, PI19/00588, PI19/00815, DTS18/00032, RD16/0009, RICORS2040 RD21/0005/0001]
- Comunidad Autonoma de Madrid FEDER-a way to build Europe [B2017/BMD-3751]
- Convocatoria Dinamizacion Europa Investigacion 2019 MINECO [EIN2019-10329 4, B2017/BMD-368 6 CIFRA2-CM]
- Innovation programme under the Marie Skodowska-Curie grant of the European Union's Horizon 2020 [812699]
- ERA-PerMed-JTC2018 [AC18/00064, AC18/00071]
- Sociedad Espanola de Nefrologia
- FRIAT
- Comunidad de Madrid en Biomedicina
- Ministerio de Ciencia e Innovacion [PID2019-104233RB-I00]
Kidney fibrosis is a characteristic of chronic kidney disease and a potential target for therapy. However, there are challenges in directly targeting kidney fibrosis. It is unclear whether fibrosis causes or results from CKD progression, and there is a lack of tools to assess kidney fibrosis in clinical practice.
Kidney fibrosis is a hallmark of chronic kidney disease (CKD) and a potential therapeutic target. However, there are conceptual and practical challenges to directly targeting kidney fibrosis. Whether fibrosis is mainly a cause or a consequence of CKD progression has been disputed. It is unclear whether specifically targeting fibrosis is feasible in clinical practice because most drugs that decrease fibrosis in preclinical models target additional and often multiple pathogenic pathways (eg, reninangiotensin-aldosterone system blockade). Moreover, tools to assess whole-kidney fibrosis in routine clinical practice are lacking. Pirfenidone, a drug used for idiopathic pulmonary fibrosis, is undergoing a phase 2 trial for kidney fibrosis. Other drugs in use or being tested for idiopathic pulmonary fibrosis (eg, nintedanib, PRM-151, epigallocatechin gallate) are also potential candidates to treat kidney fibrosis. Novel therapeutic approaches may include antagomirs (eg, lademirsen) or drugs targeting interleukin 11 or NKD2 (WNT signaling pathway inhibitor). Reversing the dysfunctional tubular cell metabolism that leads to kidney fibrosis offers additional therapeutic opportunities. However, any future drug targeting fibrosis of the kidneys should demonstrate added benefit to a standard of care that combines renin-angiotensin system with mineralocorticoid receptor (eg, finerenone) blockade or with sodium/glucose cotransporter 2 inhibitors.
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