Title : In situ regeneration needs to establish a precise cellular microenvironment to restore renal function
Abstract:
As the patients with diabetes and obesity continue to grow, the trend of increasing prevalence of ckd will not to end. The current therapeutic option for ckd is ineffective. In spite of having, adequate reserve of cells and mechanism to repair the damaged tissue is replaced by functionally inefficient fibrosis (1).. Intra- renal microvascular network disrupted due to reduction of diameter and increased tortucity of vessels. Renal oxygenation in pathophysiology of ckd progression has received lot of interest. Imbalance between delivery and consumption of renal oxygenation leading to tissue hypoxia has been important cause to development and progression of ckd. Defective renal microcirculation is a universal pathological feature in ckd (2). Improving the function of surviving nephrons by regenerating the renal micro vascularity will be logical approach Organ dis- function and failure are major health problem affecting millions of patients many are desperate for even organ transplant. Renal fibrosis represents failed wound healing process due to chronic sustained injury
Implanted cells cannot survive for long term in cell therapy because of toxic fibrotic microenvironment Efforts require to understanding mechanism of cell microenvironment so that reconstruction is possible. New innovative therapy the whole kidney ‘de novo’ regeneration; with the help of endogenous stem cells present at the site of injury by creating a supporting microenvironment. Assist and accelerate regenerative process to regrow your own new kidney in CKD. (3) The effective ant- fibrotic strategy still lacking because collagen degradation does not keep pace with collagen production. The new self-repairing method requires better understanding in mechanism and development of cell biology and morphology. (4)
The clinical trial must focus on to eliminate fibrosis to restore interstitial and glomerular capillary network. “The word regeneration means born again”. Self-organ regeneration or regenerative science is the body’s regenerative power, which is an existing in our body since birth; this awakens when required and gives results, which indicates its proof of existence. Like any other systems in our body, there is regenerative system, which consists the power of generation during foetal development and power of regeneration after birth.
Inadequate blood flow to renal tissues resulting in hypoxia causes imbalance between supply and demand.. Restore blood supply by formation of new blood vessels and perfusion of ischemic renal tissues. Angiogenesis the development of new blood vessels from pre-existing is involved in physiological and pathological disorders. (5). Preventive therapeutic strategy should be initiated in the early stages were environment is associated with adequate functional reserve is favourable towards regeneration. In let stages having toxic environment in favour of renal regression
The quickest way to go to renal fibrosis is direct anti fibrotic retrograde pressure by creating artificial block at puj, (pelvi ureteric junction) which helps in eliminating fibrosis, when the artificial block removed it opens the micro vascular capillaries improves blood supply and alter the cellular microenvironment which stimulates regeneration Blue strip stem / proj. Cells presents under the renal capsule could be basis of a new endogenous regenerative medicine capable to form new segments of nephrons in healthy microenvironment which restores damaged renal function..(6) .