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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2016; 5(3): 258-273
Published online May 6, 2016. doi: 10.5527/wjn.v5.i3.258
Stop chronic kidney disease progression: Time is approaching
Usama Abdel Azim Sharaf El Din, Mona Mansour Salem, Dina Ossama Abdulazim
Usama Abdel Azim Sharaf El Din, Departments of Nephrology, School of Medicine, Cairo University, Manial, Cairo 11759, Egypt
Mona Mansour Salem, Departments of Endocrinology, School of Medicine, Cairo University, Manial, Cairo 11759, Egypt
Dina Ossama Abdulazim, Departments of Rheumatology and Rehabilitation, School of Medicine, Cairo University, Manial, Cairo 11759, Egypt
Author contributions: Sharaf El Din UAA and Salem MM performed the majority of writing the manuscript; Abdulazim DO collected the references and highlighted the points of relevance in each article and revised the manuscript after being prepared.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Usama Abdel Azim Sharaf El Din, MD, Professor, Departments of Nephrology, School of Medicine, Cairo University, 58th Abbas El Akkad St., Manial, Cairo 11759, Egypt. usamaaas@gmail.com
Telephone: +20-11-11333800 Fax: +20-22-2753890
Received: October 25, 2015
Peer-review started: October 27, 2015
First decision: January 18, 2016
Revised: January 26, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: May 6, 2016
Abstract

Progression of chronic kidney disease (CKD) is inevitable. However, the last decade has witnessed tremendous achievements in this field. Today we are optimistic; the dream of withholding this progression is about to be realistic. The recent discoveries in the field of CKD management involved most of the individual diseases leading the patients to end-stage renal disease. Most of these advances involved patients suffering diabetic kidney disease, chronic glomerulonephritis, polycystic kidney disease, renal amyloidosis and chronic tubulointerstitial disease. The chronic systemic inflammatory status and increased oxidative stress were also investigated. This inflammatory status influences the anti-senescence Klotho gene expression. The role of Klotho in CKD progression together with its therapeutic value are explored. The role of gut as a major source of inflammation, the pathogenesis of intestinal mucosal barrier damage, the role of intestinal alkaline phosphatase and the dietary and therapeutic implications add a novel therapeutic tool to delay CKD progression.

Keywords: Chronic kidney disease, Progression, Klotho, Amyloidosis, Diabetic nephropathy, Micro RNA

Core tip: The problem of chronic kidney disease (CKD) progression is a panic, affecting both patients and physicians. The fact that such patients will sooner or later need RRT terrifies them and makes these patients to survive a continuous mare. All the trials to stop this progression in the past only delayed this progression for some time. However, in the last 2 years many genuine experimental and clinical trials revived the hope to stop the progression almost completely in the vast variety of chronic renal diseases. In this review, we are highlighting most of these trials, stressing on the different mechanisms that would stop CKD progression.