Investigating the Process of Renal Epithelial Repair to Develop New Therapies

Acute kidney injury (AKI) is a highly prevalent disease associated with poor short- and long-term outcomes as well as high costs. Although the clinical burden of AKI is increasing, the only treatment for this disease remains supportive care and dialytic therapies when indicated. By contrast, our understanding of the cellular and molecular pathways that regulate kidney repair after injury has grown substantially in recent years. There is a much clearer understanding of the critical cell types involved in kidney repair. In addition, a substantial body of evidence now indicates that repair pathways can be targeted therapeutically either to protect the kidney from injury or to accelerate repair. Examples of targetable pathways in repair include the epidermal growth factor receptor, Wnt-β-catenin, epithelial cell cycle, hedgehog, and angiopoietin pathways. This chapter reviews current knowledge regarding the cell types and molecular pathways regulating repair of kidney parenchyma, focusing on epithelial cells, endothelial cells, and stroma. Promising candidates for therapeutic targeting are highlighted, and key challenges to translation are reviewed.