Abstract
The kidney has key roles in maintaining human health. There is an escalating medical crisis in nephrology as growing numbers of patients suffer from kidney diseases that culminate in organ failure. While dialysis and transplantation provide life-saving treatments, these therapies are rife with limitations and place significant burdens on patients and healthcare systems. It has become imperative to find alternative ways to treat existing kidney conditions and preemptive means to stave off renal dysfunction. The creation of innovative medical approaches that utilize stem cells has received growing research attention. In this review, we discuss the regenerative and maladaptive cellular responses that occur during acute and chronic kidney disease, the emerging evidence about renal stem cells, and some of the issues that lie ahead in bridging the gap between basic stem cell biology and regenerative medicine for the kidney.
Highlights
The kidney performs essential physiological jobs ranging from metabolic waste excretion to homeostatic functions like osmoregulation
There is data from animal studies showing that tubular regeneration capacity diminishes with repeated insults: mice subjected to a single round of targeted destruction of tubular cells in the S1 and S2 proximal segments could regenerate through extensive tubular proliferation, but three rounds of targeted injury led to varying degrees of interstitial fibrosis [84]. It is unknown if this is the case in the S3 and other tubular segments. These findings suggest that work is needed to address how tubular regenerative capacity changes over time, and how it is influenced by past kidney health and the general progression of aging
Multipotent renal progenitor cell (MRPC) potency was demonstrated in vitro, as the cells were able to differentiate into myogenic, adipogenic, neural or osteogenic lineages; further, MRPCs differentiated into renal tubular cells after they were injected into the parenchyma of damaged murine kidneys [113]
Summary
The kidney performs essential physiological jobs ranging from metabolic waste excretion to homeostatic functions like osmoregulation. MRPC potency was demonstrated in vitro, as the cells were able to differentiate into myogenic, adipogenic, neural or osteogenic lineages; further, MRPCs differentiated into renal tubular cells after they were injected into the parenchyma of damaged murine kidneys [113] Another group isolated what they termed mouse kidney progenitor cells (MKPC) from the interstitium of the medulla and papilla that exhibited self-renewal capacity and expressed early nephrogenesis genes [114]. Developmental studies are applicable for understanding regeneration because information about how kidney lineages are formed can provide gene expression data that could help pinpoint adult renal stem cells and the signaling pathways that modulate the mobilization and behavior of reparative cells. Primary cilium signaling may hold a prominent position in the course of events that lead to nephron regeneration or maladaptive responses
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