జర్నల్ ఆఫ్ నెఫ్రాలజీ & థెరప్యూటిక్స్

Renal Replacement Therapy holds pivotal significance in addressing end-stage renal disease (ESRD), marked by irreversible kidney function decline. With ESRD prevalence escalating worldwide, the urgency for proficient and impactful RRT solutions intensifies. Recent technological progressions have reshaped the kidney care domain, presenting unprecedented avenues for enhancing patient outcomes and quality of life during RRT. This piece delves into the profound influence of technology on the evolution of renal replacement therapy and its far-reaching implications for kidney care. Before exploring the impact of technology, it's crucial to grasp the fundamentals of Renal Replacement Therapy (RRT). RRT encompasses diverse treatment approaches aimed at substituting the critical functions of the kidneys in individuals with ESRD. The primary RRT methods include hemodialysis, peritoneal dialysis, and kidney transplantation.

Diabetic kidney disease remains a significant complication of diabetes mellitus, contributing to considerable morbidity and mortality globally. Despite advancements in treatment, the management of DKD remains challenging, necessitating the exploration of novel therapeutic approaches. Recently, there has been a surge of interest in targeting macrophages, key immune cells implicated in the pathogenesis of DKD, as a promising avenue for intervention. This review provides an overview of the role of macrophages in DKD and discusses emerging therapeutic strategies aimed at modulating their function to mitigate renal damage and improve patient outcomes. Macrophages play a pivotal role in DKD pathogenesis by promoting inflammation, fibrosis, and tissue injury within the kidney. Therapeutic approaches targeting macrophages encompass modulation of macrophage recruitment, polarization, and function. Inhibition of chemotactic signals and promotion of anti-inflammatory M2 polarization have shown promise in preclinical models of DKD. Additionally, advancements in drug delivery technologies, such as nanoparticle-based systems, enable targeted delivery of therapeutic agents to macrophages within the kidney, enhancing therapeutic efficacy while minimizing off-target effects. Cell-based therapies, particularly mesenchymal stem cell transplantation, offer a potential avenue for modulating macrophage activity and promoting tissue repair in DKD. However, several challenges, including precise targeting of macrophages, optimization of drug delivery, and identification of biomarkers for treatment monitoring, need to be addressed. Despite these challenges, targeting macrophages holds significant promise as a therapeutic strategy for DKD, offering the potential to attenuate inflammation, fibrosis, and renal injury. Continued research efforts are essential for translating these findings into clinical practice and improving outcomes for patients with DKD.

Glomerular diseases present a complex clinical landscape characterized by diverse manifestations and variable disease courses, posing significant challenges in diagnosis and management. This review examines the clinicopathological features, disease progression, and therapeutic approaches in glomerular diseases to enhance understanding and optimize patient care. Clinical presentations encompass proteinuria, hematuria, hypertension and renal insufficiency, reflecting underlying inflammation, immune complex deposition, or genetic abnormalities affecting glomerular structure and function. Histological examination remains pivotal for accurate diagnosis, revealing characteristic patterns such as mesangial proliferation, immune complex deposition, and podocyte injury. Longitudinal studies offer insights into disease trajectories and predictors of adverse outcomes, informing therapeutic decision-making. Treatment strategies aim to reduce proteinuria, preserve kidney function, and mitigate complications, often employing immunosuppressive agents and renin-angiotensin-aldosterone system inhibitors. Individualized treatment plans tailored to clinicopathological characteristics are essential for optimizing outcomes. Despite diagnostic challenges, multidisciplinary approaches integrating clinical, laboratory, and histopathological assessments facilitate accurate diagnosis and prognostication. Prognostic markers guide risk stratification and targeted interventions, emphasizing the importance of early identification and personalized management. By elucidating the intricate interplay of clinical and pathological features, this review informs clinicians and researchers, guiding efforts to improve diagnostic accuracy and therapeutic efficacy in glomerular diseases.

Diabetic kidney disease represents a significant complication of diabetes mellitus, contributing to the escalating global burden of end-stage renal disease. Exercise has emerged as a crucial non-pharmacological intervention for managing DKD, offering protective effects against its development and progression. This article reviews the epidemiological evidence supporting the benefits of exercise in DKD and elucidates the underlying molecular mechanisms involved. Epidemiological studies consistently demonstrate an inverse relationship between physical activity levels and DKD risk, with regular exercise associated with improvements in renal function, reduction in albuminuria, and attenuation of renal fibrosis. At the molecular level, exercise exerts multifaceted effects on key pathophysiological pathways implicated in DKD. These include enhancing insulin sensitivity, promoting glucose uptake, reducing systemic inflammation and oxidative stress, modulating the renin-angiotensinaldosterone system and endothelin pathways, and inducing adaptations in skeletal muscle metabolism. Furthermore, exercise activates antiinflammatory and antioxidant responses within the kidney, mitigating renal inflammation, oxidative stress, and fibrosis. Understanding the molecular mechanisms by which exercise confers renal protection in DKD is essential for optimizing therapeutic strategies and promoting early intervention to delay disease progression. Therefore, integrating exercise into comprehensive management plans for individuals with diabetes may offer significant benefits in preserving renal structure and function, ultimately improving clinical outcomes and reducing the burden of DKD.