As the main responsible agents for filtering out toxins and waste products from our bodies, the kidneys also play a major role in keeping overall fluid and electrolyte balance as well as additional important functions and homeostasis.
Types of Kidney Disease
There are many reasons why kidney problems develop, but kidney diseases can usually be classified into acute or chronic or as primary or secondary renal disorder.
Severe acute or chronic kidney disease can cause progressive damage to kidney functions which eventually may result in impaired filtration, resulting in renal failure, accumulation of urea, potassium, or other waste products, anemia caused by lack of erythropoietin, an essential growth factor for production of red blood cells and additional complications. Eventually, renal failure results in the need for renal dialysis or kidney transplantation.
Symptoms and Progression of Kidney Disease
Early-onset kidney disease usually causes symptoms of intoxication. These may include:
- Increased thirst
- Swelling of feet or ankles
- Frequent urination or lack of urination
- Nausea or vomiting
If left untreated, kidney disease can cause a dangerous accumulation of minerals and toxins, especially potassium (K). This can be dangerous and turn deadly.
Traditional Management of Kidney Disease
Whereas acute renal failure may be reversible, chronic renal failure is usually not reversible and tends to result in technical and medical complications that increase with time.
Chronic dialysis can improve a patient’s condition, but it is indicated for several hours 2 or 3 times a week. It is invasive, inconvenient, accompanied by complications, expensive and if access to the vascular system of the patient becomes problematic, it can also become technically difficult.
At this point, a kidney transplant becomes the next best solution, using either a living volunteer or a deceased donor if available. Unfortunately, the availability of kidneys from deceased donors is subject to a long waiting list. Sometimes elderly patients are not considered eligible to be on the waiting list, as preference is given to younger patients in need. Taken together, the need for alternative treatment for patients with renal failure remains an unmet need.
Mesenchyman Stem cells for Renal Failure Treatment
Chronic renal failure is the end result of the damage to kidney function that results from inflammatory processes that destroy the normal function of the glomeruli filtering the blood. This results in fibrosis and replaces the normal cells responsible for the normal function of the kidney.
Based on the documented anti-inflammatory effects of MSCs and their potential therapeutic effects against fibrosis (or the formation of scars that replace the normal structure of the filtration process), we have speculated that treatment of renal failure may be reversed in part by treatment with MSCs. Accordingly, we have examined the regenerative capacity of multi-potent MSCs in pre-clinical models in mice and rats.
Results obtained by two independent teams using different animal models confirmed positive therapeutic effects following treatment with MSCs. Based on these encouraging results, we have pioneered an experimental treatment of chronic renal failure in a consenting 66 years old patient with a 10-year-long history of diabetes and myasthenia gravis, who was being treated with insulin and mestinon.
This patient suffered from chronic renal failure, most likely caused by diabetic nephropathy, and needed hemodialysis three times a week for two years. Following one single treatment with MSCs derived from his daughter’s bone marrow, the patient maintained a normalmaintained normal lifestyle and full-time activity in his factory with no need for renal dialysis for over 4 years.
Although his creatinine levels (a main indicator of renal failure) remained elevated, the patient’s general condition and performance status remained normal. Interestingly, after being treated with haploidentical MSCs there was also no further need for treatment with insulin. The surprising feasibility to improve both impaired renal function and diabetes through safe intravenous treatment with MSCs needs to be further evaluated and confirmed in prospective clinical trials. These trials need to be conducted in patients with diabetic nephropathy and with other causes of chronic renal failure alike.
The potential use of MSCs for insulin sparing effects for treatment of patients with type 1 and type 2 diabetes should also be considered based on the surprising effects of treatment of our first patient. Since he also suffered from myasthenia gravis in the past, clearly an autoimmune disease, the regenerative effects against renal failure may also be due in part to regulation of immune mediated anti-self-reactivity.