Dear Colleagues,
Any congenital or acquired renal damage to the kidneys that is persistent is considered a Chronic Kidney Disease (CKD). Chronic Kidney Disease (CKD) has a high prevalence; it is estimated that 10% of an adult population in developed countries have some kidney damage. Kidney damage is progressive and, eventually, leads to end-stage renal disease (ESRD). Patients with ESRD need dialysis or kidney transplantation to live; these treatments are expensive and often to not enable a normal life.
Renal function is usually determined by the measurement of the Glomerular Filtration Rate (GFR), which is the amount of blood which is filtered by the kidney. The renal tubules have an important role in producing urine, reabsorbing and secreting several substances. Furthermore, the kidneys produce renin, vitamin D, erythropoietin, and Klotho protein, which control vascular wall integrity, erythropoiesis and bone composition. Nevertheless, according to Bricker’s hypothesis of the intact nephron, the renal function depends on the number of nephrons. Residual nephrons may compensate the loss or the congenital reduction in number, increasing the individual GFR. The increase in GFR is called the “renal reserve”, which is difficult to measure. According to Brenner’s hypothesis, this causes hyperfiltration, leading to irreversible damage to the glomeruli and eventually end-stage renal disease (ESRD). A recent classification of the stages of CKD takes into consideration the GFR and the proteinuria, which is probably a measure of the hyperfiltration. The progression to End-Stage Renal Disease (ESRD) is variable according to the cause of renal disease (glomerular diseases produce a faster decline in renal function compared to interstitial diseases); many factors are thought to be involved (high sodium, phosphate or protein consumption in the diet, high blood pressure, drugs, etc.). A low-protein diet, ACE inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and SGLT2 inhibitors may reduce the progression to ESRD. The early introduction of treatment is important in reducing CKD progression. Unfortunately, the diagnosis of renal insufficiency is often late. A considerable percentage of patients with ESRD do not receive a diagnosis. Congenital Abnormalities of the Kidney and Urinary Tract (CAKUT) may be neglected and affected children reach ESRD in adulthood. A considerable percentage of patients who receive a kidney transplant develop a renal insufficiency. Several factors may contribute to this: immunosuppressive therapy, other drugs, hypertension, recurrence of the renal disease, etc. Premature and low-weight new-borns are prone to developing kidney disease in their lives. Patients who suffer from acute kidney injury may recover but a percentage will develop CKD later in their life.
Collecting original works in a topic collection of a journal gives researchers the opportunity to learn, share ideas, and participate in collaborative studies. Original papers dealing with the definition, causes, diagnosis, evaluation, and treatment of renal disease are welcome.
Dr. Silvio Maringhini
Collection Editor
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