Nanomedicine and Therapeutics of Kidney Diseases
Kidney disease has become a critical health issue for the global population, especially with diabetes mellitus (DM) becoming ubiquitous in developing countries. Approximately 37 million Americans suffer from chronic kidney disease, and critical diabetes statistics indicate that one in three people with diabetes develop chronic kidney disease.
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With advances in nanomedicine, the development of a less risky and invasive procedure to assess kidney tissue for diagnostic purposes has become a priority. This would help to increase the accuracy of diagnoses and the quality of treatment.
While kidney disease is widespread in the United States, the lack of awareness of this disease among people with this disorder is staggering. About 9 out of 10 people have chronic kidney disease without a diagnosis or knowledge of the impaired condition of their kidney.
Interestingly, this is due to the early stages of kidney disease showing no symptoms, allowing the disorder to progress to later stages undetected. The severity of this phenomenon leads to adverse health effects including deterioration of kidney function leading to kidney failure and even other health problems such as strokes or heart attack.
It is estimated that 2 out of 1000 people in the United States suffer from end-stage renal disease, which at present can be treated with a kidney transplant or dialysis.
Significant role of the kidneys
Kidney disease that has been caused by diabetes-related damage is also known as diabetic nephropathy. It is a slowly progressive disease that develops over several years, with 1 in 5 people with the condition requiring treatment.
The importance of this lies in the critical role the kidneys play in the body. The kidneys primarily function as a filter for the blood, with extra fluids and waste products being removed through urine, along with medications and toxins.
Other important functions include regulating water balance by retaining excess water or releasing excess water in urine. When the former occurs, it results in more water entering the blood vessels, which subsequently leads to an increase in blood volume and pressure.
The varied roles the kidneys play illustrate the requirement for functioning kidneys and the critical need for innovative medical solutions to traditional medicine to diagnose and manage kidney disease.
Kidney Disease Challenges
High blood pressure and high blood sugar can contribute to kidney damage due to the impact on the small blood vessels of these critical organs. This can lead to leakage, causing abnormal volumes of blood protein to be eliminated through urine, illustrating signs of early kidney disease.
Other symptoms of kidney disease that may be seen as the disease progresses include swollen ankles, feet, and hands, blood in the urine, fatigue, shortness of breath, and nausea. This is due to the challenge of the kidneys to release excess fluid and waste, illustrating the need for annual kidney tests for effective functionality, maintenance of blood sugar levels and reduction of blood pressure.
The gold standard for evaluating renal fibrosis is by renal biopsies and histopathological evaluation. Although this approach is widely used, it is known to be a risky and invasive procedure with limited value. This is because the extent of the assessment is so small, with a kidney biopsy examining only 0.01% of kidney tissue and resulting in ineffective diagnoses.
Subsequently, less than 10% of patients use this procedure, which can also impact a healthcare professional’s ability to accurately stage a patient’s disease progression.
Other challenges facing traditional medicine include treatment management, such as suppression of the renin-angiotensin system for hypertension control as well as drugs to control diabetes. The limitations of these standard treatment options consist of undesirable side effects, including hypoglycemia and diuresis.
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Innovative applications in nanomedicine
Nanomedicine has become a branch of medicine that aims to advance traditional notions of diagnosis and therapy. This includes the use of nanoparticles and nanomaterials of nanometer size, typically 1 and 100 nm, with high surface functionalization and targeting ability to treat areas of concern in the body without harming healthier regions.
Nanoparticles may hold great potential for theranostics as they can efficiently transport drugs and increase image contrast when used in bioimaging. This can allow a deeper insight into the functionality of a patient’s kidneys without the invasive procedure of a potentially ineffective biopsy.
As nanomedicine and nanoparticles in research have gained ground, with more than twenty nanoparticles receiving FDA approval for the treatment of cancer, their role in diabetes continues to grow.
Some challenges facing nanoparticles for the treatment of kidney disease in several studies reported a lack of stability live as well as ineffective targeting in the renal space. The reality of this potential therapeutic approach surrounds the inefficiencies of biodistribution and metabolism.
However, other studies have been more optimistic about this innovative theranostic technique by describing its promising application in targeting kidney tissue. Better understanding the anatomy of the kidneys is essential to using nanoparticles for this function, as it would enable success.
Path to clinical success
Further research in this area to improve the application of nanoparticles for kidney disease would include exploring other routes of administration as opposed to the conventional IV that is used, such as intraperitoneal administration. Moreover, the nanoparticles must cross the glomerular filtration membrane and reach the proximal tubule, which requires that the particle size be less than seven nm and that they be positively charged.
Another area of research includes surface functionalization, using ligands to target kidney damage; this may include targeting cell adhesion molecules presented by inflammatory kidneys such as E-selectin. Targeting these peptides through nanocarriers that deliver drugs to the target site, such as an immunosuppressant, may help manage the kidney disease with fewer side effects.
The Centers for Disease Control and Prevention (CDC) reports on chronic kidney disease found that this condition was more common in women (14%) than in men (12%). In addition, this disease is more common in people aged 65 or over, with a rate of 38%.
Further research into innovative solutions such as nanomedicine for theranostics can ensure patients of all ages have effective earlier-stage diagnoses and help manage kidney disease for a better quality of life.
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Further reading and references
States, K. and Health, N., 2022. United States Kidney Disease Statistics | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available on :
Tillman, L., Tabish, T., Kamaly, N., Moss, P., El-briri, A., Thiemermann, C., Pranjol, M. and Yaqoob, M., 2022. Advances in Nanomedicine for Detection and the treatment of diabetic nephropathy. Biomaterials and Biosystems, 6, p.100047. Available at: https://doi.org/10.1016/j.bbiosy.2022.100047
UK, D., disease), D., confidence, M. and disease?, L., 2022. Diabetic nephropathy (kidney disease). [online] Diabetes UK. Available on :
Yamazaki, T., Mimura, I., Tanaka, T. and Nangaku, M., 2021. Treatment of diabetic kidney disease: current and future. Diabetes & Metabolism Journal, 45(1), p.11-26. Available at: 10.4093/dmj.2020.0217
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Healthcare (IQWiG); 2006-. How do the kidneys work? November 18, 2009 [Updated 2018 Mar 8]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279385/