Technological Advances In Treating Kidney Disease
No man is an island. Every human being needs to interact with another human being at some point in their lite to have a meaningful and fulfilling existence. Similarly, no branch of science can remain in isolation, without being in touch with other branches of science.
In our endeavour to provide quality health care, the various arms of science like basic research, engineering, information technology and human and veterinarian medicine need to have a common interface and co-operate with each other in order to treat patients better. Thus, engineering products like MRI, CT Scanners, ultrasound machines, automated lab analysers and microscopes, IT products like computers and I- pads, physicians and veterinarians need to work in close harmony to appropriately utilise technology in patient care. In kidney disease, like in any other disease, early diagnosis and safe and effective treatment is the cornerstone to better patient outcomes.
Since the past few decades, the level of creatinine in the blood has been used as a marker for diagnosing kidney disease. Higher the creatinine, the worse the kidney function. Creatinine levels are a cheap and easy means to estimate kidney function. However, creatinine levels do not give an early indication of kidney disease. In fact, it takes at least 36-48 hours for creatinine to rise after the onset of kidney failure. By the time the creatinine levels start rising in an individual, 20 to 25 percent of kidney damage has already occurred.
Further, rising creatinine levels are not specific to kidney disease alone and can happen in very muscular individuals, after a high protein diet or in response to certain medicines without affecting kidney function. To complicate matters more, in an established kidney disease, creatinine levels cannot predict the progression or onset of complications.
Therefore, in a desperate search for an ideal marker of kidney function, various technically advanced auto-analysers, microscopes and reagents have been experimented with, Fortunately, today we have plenty of biochemical and urinary biomarkers ‘n our arsenal to specifically and rapidly diagnose kidney ailments. Some of them are mentioned below.
- Cystatin C
This is measured in the blood and identifies kidney disease at least 24 hours earlier than creatinine and with much greater specificity.
- Neutrophil Gelatinase Associated Lipocalin
- Measured in the blood and urine, it identifies kidney disease within two hours of onset.
- Interleukin 18
- Measured in urine, it detects kidney injury within one to 24 hours of onset.
- Kidney Injury Molecule – 1
Estimated in urine, it identities kidney injury within one to 24 hours.
- Carbamylated Haemoglobin
It is often difficult to differentiate between recent onset versus pre-existing kidney disease in a particular patient. High levels of carbamylated haemoglobin indicate kidney disease since at least three months.
- SuPAR Levels
High levels of soluble urokinase-type plasminogen activator receptor (SuPAR) indicate a higher risk of progression of kidney disease in an individual with pre existing kidney disease.
- Fibroblast Growth Factor – 23
Can be used to monitor the progression of established kidney disease.
- Urinary Granyme B and Perforin levels
These indicate rejection of transplanted kidneys and in certain situations may replace the more invasive process of kidney biopsy.
- Kidney Biopsy
A kidney biopsy answers four fundamental questions – what Is the problem, since when it is, what Is the treatment and what is the outcome. With the technology of real-time ultrasound at our disposal, kidney biopsy is a very safe and accurate procedure. With the newer electron microscopes which magnify the images more than a thousand times, even a single unit of the kidney in the biopsy sample is enough to clinch the underlying diagnosis.
End stage renal disease (ESRD) is the most dreaded complication of kidney disease. Patients with ESRD have only two options of treatment – dialysis or kidney transplant. Dialysis machines these days are extremely efficient and user-friendly and different modalities and hybrids of basic forms of dialysis can be performed on them. These machines have in-built computers which enable programming, memory and data storage in addition to their basic functions.
Dialysis these days is more comfortable for the patient than 10 years ago, thanks to new technology. However, no amount of physical comfort can make up for the discomfort of being tethered to a machine for 12 hours every week and punctured by large needles each time. Peritoneal dialysis is no better as the patient has to undergo three to four exchanges daily. The patient is attached to a peritoneal dialysis machine all night as they need to be connected every night and disconnected in the morning.
The only feasible way a patient can be freed from dialysis is to undergo a transplant which entails the availability of a suitable donor, undergoing a major surgery, facing the risks of kidney rejection and taking highly toxic immunosuppressive medications for life. The only solution for this is to manufacture an artificial kidney and thankfully we are on the threshold of this major breakthrough. Research groups all over the world are working on overdrive to make this dream come true. Mentioned here is a list of some of the latest products being developed in laboratories.
- Artificial Kidney
This is a ten pound wearable artificial kidney attached as a belt around the waist and is projected to keep dialysis dependent patients out of the dialysis unit. It is being developed by the University of Washington in collaboration with the US Food and Drug Administration (FDA).
- Bloartificial Kidney
Being developed by the Implantable Artificial Kidney Corporation, it is made of human cells embedded on a base of silicon and plastic and can be implanted in the circulatory system. The device is meant to be permanent but if failures occur, it can be easily replaced by a minimally invasive surgery.
- Implantable Artificial Kidney
Also called implantable renal assist device (iRAD), it includes thousands of microscopic filters, a bioreactor and live kidney cells to mimic all the roles of a real kidney. With silicon fabrication technology, attempts are being made to reduce it from the size of a room to that of a cup. It is being researched by the University of California, San Francisco (UCSF) and may be available for use by 2020.
- Stem Cell Kidney
This is produced by bone marrow stem cells which secrete hormones that correct kidney disease.
- 3-D Kidney
Here, the tailed kidney is taken out from the patient and the cells stripped down, leaving behind a 3-D scaffold of the kidney. Then, donor blood vessels and kidney cells are used to re-populate it resulting in a working, brand new kidney. Experiments done so tar, have been successful.
- Cloned Kidney
In a revolutionary move, a few skin cells are taken from a cow’s ear and fused with a cow egg to produce stem cells. These cells are converted into kidney cells which grow into a functioning kidney after being implanted on a biodegradable kidney-shaped scaffold. Since the cells are genetically identical to the donor animal, rejection does not occur. Human experiments will start shortly according to experts at Harvard Medical School.
With all this research, there is real hope that dialysis and kidney transplant will be a thing of the past and patients with kidney disease can lead a normal life with artificial kidneys which are safe, effective and compatible.
Stone Disease And Technological Advances
Kidney stone disease has been affecting at least 10 per cent of the human race since centuries. Till 1980, the only available treatment was surgical removal of the stone. Since then, extracorporeal shock wave lithotripsy (ESWL) using ultrasound waves to break and remove the stones became the standard of care. Later, laser therapy with thulium, yttrium and other radioactive materials were used.
Today, experimental thulium fibre laser (ETFL) is being increasingly thought of as a means of treating kidney stones. In head-to-head studies between ESWL and ETFL, it was concluded that ETFL is better than ESWL for stones smaller than 10 mm as there is less pain, infection and bleeding with it. However, it is costlier, needs greater expertise and knowledge.
Apart from the technical breakthroughs listed above, boom in the IT sector has led to mushrooming of patient portals, telemedicine, video conferencing, electronic medical records and various social media platforms. This enables closer interaction between patient and-patient, patient-and-doctor and doctor-and -doctor for better knowledge sharing and patient care. Technological advances have definitely contributed positively to patient care but further research and refinement is needed to move them from the bench-to-bedside.