Picture this: a future where kidney diseases are no longer a dreaded problem, where treatments are not just effective but also revolutionized to improve patients’ overall well-being. It is no longer just a daydream. Cutting-edge breakthroughs are now becoming a reality.
In the United States alone, there are an estimated 37 million people who have chronic kidney disease (CKD), and I am one of them. Back in 2015, when I was a sophomore in high school, I was first referred to a nephrologist. During a regular physical with my pediatrician, which included a urine test, it was discovered that I had protein in my urine. This abnormality prompted my pediatrician to recommend seeing a nephrologist at Children’s Hospital Los Angeles, where I underwent a blood draw and another urine test. After the results from these tests came back, my nephrologist ordered a biopsy on my kidney, which led to my diagnosis of IgA nephropathy (IgAN). As a teenager, all of this was overwhelming, as neither I nor my parents had ever considered the possibility of kidney disease. What made it even more surprising was that I did not feel sick at all. It was a revelation to learn that kidney disease often presents with little to no symptoms.
CKD is an escalating public health issue in the United States, with various reasons contributing to kidney failure, such as genetic factors or rare diseases. However, the primary causes of CKD are diabetes and high blood pressure. Innovation is crucial for improving patient outcomes, addressing unmet needs of those with kidney disease, enhancing access to care, and promoting personalized medicine. I want to highlight three innovations in the treatment of kidney disease: a new drug for IgAN, two new medications for lupus, and advancements in stem cell-based therapy. These innovations give me hope for the future as someone with kidney disease, knowing there are advancements being made to improve our outcomes and quality of life, with the hope that they will eventually become widely accessible for all patients.
IgAN, an autoimmune disease characterized by deposits of the antibody IgA in the kidneys, currently has no cure. However, an exciting development in IgAN management received full FDA approval in 2021, offering renewed hope for people like me. This new treatment targets the gut, where the antibody IgA is produced, and reduces the amount of this antibody. A study has shown that this treatment leads to a significant reduction in protein in the urine. Additionally, another non-immunosuppressive therapy for IgAN received FDA approval in 2023.
I have a vivid memory of attending American Society of Nephrology’s (ASN) Kidney Week last year in Philadelphia. It was evident that there was a significant surge in interest and advancements related to IgAN, which was truly encouraging. Witnessing such progress instilled a sense of optimism and hope not just for my own future but also for my peers who are fighting this illness.
Lupus nephritis, a form of kidney disease caused by systemic lupus erythematosus (SLE), can worsen over time and result in kidney failure. Two new therapies approved in 2021 offer hope for better treatments specifically targeted to address lupus and lupus nephritis. Unlike older medications which suppress the entire immune system, these new drugs target specific molecules. One therapy, taken orally, inhibits the activation of T cells responsible for autoimmune responses, effectively reducing kidney inflammation. Clinical trials have shown its superiority in preventing kidney inflammation compared to standard treatment. The other therapy, administered intravenously, blocks type 1 interferon (IFN-1) activity which triggers inflammation. These advancements in lupus treatment provide hope for improved outcomes and can help save people’s kidneys.
For those with end-stage renal disease (ESRD), the current treatment options are transplantation or dialysis. I am grateful to have options. However, dialysis can be burdensome, and transplantation is limited by organ shortages and is not a cure, it is just another form of treatment. Stem cell-based therapy research offers a potential alternative. Stem cells, particularly mesenchymal stromal cells, have shown promise in regenerating damaged kidney tissue, reducing inflammation, and improving cell survival. While early human trials have demonstrated safety, replicating the positive results seen in animal models remains a challenge. Ongoing clinical trials will contribute to our understanding and determine the effectiveness of stem cell-based therapy in kidney diseases.
Genetic variations in the APOL1 gene are linked to a higher risk of kidney disease among African Americans. These variations are only found in people with African ancestry and offer increased immunity against African trypanosomes. If both parents have this gene, the likelihood of developing kidney failure is elevated. Genetic testing can be done to identify individuals with a higher risk of kidney disease.
It is reassuring to know there are ongoing innovations in all stages of kidney research. These exciting advancements in kidney care should inspire us to remain informed and engaged in our own treatment. It is important to communicate with our doctors and explore available options. Medication adherence and routine doctor visits are crucial for maintaining good health, and strategies like setting reminders and sticking to a consistent schedule can help us stay on track.
I hope these advancements bring optimism to our journey and serve as a beacon of hope, not just for me but for everyone facing kidney disease. Let’s stay positive and well-informed, and support the potential breakthroughs which can positively impact our lives.
Isela King, MPH, is the administrative coordinator at Renal Support Network. She was diagnosed with IgA nephropathy in 2015 when she was a sophomore in high school. This is the same year she began volunteering at RSN’s Renal Teen Prom. She received her Master of Public Health degree from the Keck School of Medicine and hopes to use it to continue to serve her peers in the kidney community.
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