Innovations in Nephrology: Breakthrough Technologies in Kidney Disease Care

Foreword
Contents
Chapter 1: From Hippocrates to Robotics: A Journey Through the History of Nephrology
1.1 Introduction
1.2 Hippocrates and the Kidneys
1.3 The Kidneys in the Bible
1.4 Historical Landmarks of Nephrology
1.5 Twentieth Century Landmarks in Nephrology
1.6 Hypertension Historical Landmarks
1.7 The Development of Nephrology as a Medical Specialty in the Twentieth Century
1.8 Technologies Applied to Nephrology
1.8.1 Hemodialysis
1.8.2 Peritoneal Dialysis
1.8.3 Kidney Transplant
1.8.4 New Technologies
1.9 Conclusion
References
Chapter 2: Genetic Engineering of the Kidney
2.1 Introduction
2.2 Kidney Gene Therapy
2.3 Vector Systems in Kidney Gene Therapy
2.3.1 Adenoviral Vectors
2.3.2 Adeno-Associated Viral Vectors
2.3.3 Lentiviral Vectors
2.3.4 Genetic Modification of the Kidney During Ex Vivo Machine Perfusion
2.3.5 MHC Antigens as Targets in Transplant Rejection
2.3.6 Genetic Engineering the Kidney to Downregulate MHC Expression
2.4 Future Perspectives and Conclusion
References
Chapter 3: Stem Cells: Use in Nephrology
3.1 Introduction: Stem Cells and Kidney Diseases
3.2 Sources of Stem Cells for Renal Therapy
3.2.1 Embryonic Stem Cells (ESC) and Induced Pluripotent Stem Cell (iPSC)
3.2.2 Mesenchymal/Stromal Stem Cells
3.2.3 Renal Stem Cells
3.2.4 Cell-Free Therapy: Extracellular Vesicles from IPS, MSC, and Kidney Progenitor Cells
3.3 Mechanism of Action of Stem Cells on Cellular Therapy
3.3.1 ESC and iPSC
3.3.2 MSC
3.3.3 Extracellular Vesicles
3.4 Kidney Organoids
3.5 Stem Cell/Renal Stem Cells Applied to Renal Tissue Engineering
3.6 Clinical Translation of Stem Cells in Kidney Diseases
3.7 Ethics and Legal Regulation
3.8 Conclusion
References
Chapter 4: Proteomics and Biomarkers for Kidney Diseases Diagnosis
4.1 Introduction
4.2 Concepts of Proteomics-Based Technology
4.3 Sampling, Urine Normalization, Factors Affecting Proteomics
4.4 Proteomic Analysis on the Specific Site of Kidney, an Initial Step of Biomarker Discovery
4.5 Proteomic Analysis on Urine Extracellular Vesicles
4.6 Current Biomarkers of Kidney Diseases Derived from Proteomic Analysis
4.6.1 Glomerular Diseases
4.6.2 Diabetic Kidney Disease (DKD)
4.6.3 Acute Kidney Injury (AKI)
4.7 Future Perspectives
References
Chapter 5: Single Cell Transcriptomics
5.1 Introduction
5.2 The Fundamentals of scRNA-seq
5.2.1 snRNA-seq vs. scRNA-seq
5.2.2 scRNA-seq Methodology
5.2.3 Data Analysis
5.2.4 Complementary Technologies for scRNA-seq
5.3 Applications of scRNA-seq in Nephrology
5.3.1 scRNA-seq in Mouse Studies
5.3.2 scRNA-seq in Human Kidneys
5.3.3 scRNA-seq in Kidney Organoids
5.3.4 Publicly Available Data Source
5.4 Future Perspectives
5.5 Conclusion
References
Chapter 6: Gut Microbiota and Chronic Kidney Disease
6.1 Epidemiological Scenario
6.2 Gut Microbiota and Chronic Kidney Disease
6.2.1 Microbiome: An Evolutionary Perspective
6.3 Microbiota and Its Implications for Pathologies
6.4 Microbiota and Its Influence on Therapy
6.5 Conclusion
References
Chapter 7: Artificial Food and the Future of Nutrition for Kidney Health
7.1 Introduction
7.2 The Present
7.2.1 Dietary Patterns and Kidney Diseases
7.2.2 Nephrotoxins from Diet and Agricultural Production
7.3 The Future
7.3.1 Food Production and Introduction of Artificial Food
7.3.2 Future of Nutrition for Kidney Health
References
Chapter 8: Novel Drugs for Kidney Diseases Treatment
8.1 Introduction
8.2 SGLT2 Inhibitor Drugs
8.2.1 Dapagliflozin
8.2.2 Canagliflozin
8.2.3 Empagliflozin
8.3 NF-E2-Related Factor 2 Activator
8.4 Hypoxia-Inducible Factor Prolyl Hydroxylase (HIF-PH) Inhibitors
8.5 Incretin-Based Drugs
8.6 Mitochondria-Targeted Agents
8.7 Final Tasks
References
Chapter 9: 3D Printing in Nephrology
9.1 Bioprinting
9.1.1 History of Bioprinting
9.1.2 Tissue Engineering
9.1.3 Bioprinting Methods
9.2 Kidney Bioprinting
9.2.1 Kidney Function
9.2.2 Phantom
9.2.3 Kidney Bioprinting
9.3 Current Kidney Regeneration Studies
9.3.1 Kidney Organoids
9.3.2 Fabrication of the Urine Excretion Pathway
9.3.3 Decellularization
9.4 Research in our Laboratory
9.4.1 Development of the Kenzan Method
9.4.2 The Kenzan Method and Bio-3D Printing Have Enabled the Fabrication of Various Structures
9.4.3 Development of Human Vascular Grafts
9.4.4 Clinical Research of Vascular Graft and Nerve Conduct
9.4.5 Prospects for Regenerative Kidney Medicine
References
Chapter 10: Kidney-on-a-Chip
10.1 Introduction
10.2 Examples of Proximal Tubule-on-a-Chip
10.3 Glomerulus-on-a-Chip
10.4 Nephron-on-a-Chip
10.5 Multi-Throughput Screening
10.6 Kidney Organoid-on-a-Chip
10.7 Multi-Organ-on-a-Chip
10.8 Ongoing Developmental Challenges
10.9 Conclusion
References
Chapter 11: Innovations in Maintenance Dialysis Therapy
11.1 Introduction
11.2 Hemodialysis Innovations from a Value-Based Care Perspective
11.2.1 Enhance Dialysis Efficacy
11.2.1.1 Convective-Based Therapies (Enhanced External and Internal Filtration)
11.2.1.2 Intensive Dialysis
11.2.2 Improve Cardiovascular Outcomes
11.2.2.1 Fluid Management
11.2.2.2 Feedback-Controlled Tools
11.2.3 Facilitate Acceptance of Alternative HD Delivery Modes
11.2.3.1 Home Therapy
11.2.3.2 Personalized Therapy
11.2.4 Ensure Vascular Access Sustainability
11.2.4.1 Implement Continuous Quality Improvement Programs with Support of Digital, Advanced Analytics, and Artificial Intelligence
11.2.5 Final Considerations for HD Innovations
11.3 Peritoneal Dialysis Innovations
11.3.1 Innovations in PD Access, Catheter Design, and Insertion Techniques
11.3.2 Connectology Assistance
11.3.3 Peritonitis Diagnosis
11.3.4 Patient-Directed Therapy
11.3.5 Enhancing Uptake and Maintaining Numbers on PD
11.3.6 What About Innovation in PD Solutions and Its Mostly Used Osmotic Agent (Glucose)?
11.3.7 Final Considerations for PD Innovations
11.4 Future Perspectives
References
Chapter 12: Dialysis for Business and Society: From a Shareholder to a Stakeholder Perspective in Dialysis Units Management
12.1 Introduction
12.2 The Traditional View
12.3 The Stakeholder Framework
12.4 Dialysis for Business… and Society
12.5 Dialysis Unit Stakeholders
12.5.1 Patients
12.5.2 Healthcare Workers
12.5.3 Shareholders
12.5.4 Government
12.5.5 “Community”
12.5.6 Suppliers
12.6 Conclusion
References
Chapter 13: Generation of Whole Kidney and Other Possible Strategies to Renal Replacement Therapy in the Future
13.1 Introduction
13.2 Xenotransplantaion
13.3 Organoids
13.4 Chimera Technology Introduction
13.4.1 Blastocyst Complementation (Primary Chimerism, Systemic Chimerism)
13.4.2 Fetus Organ Complementation (Secondary Chimerism, Local Chimerism)
References
Chapter 14: Bioartificial Kidneys, Renal Epithelial Cell Systems, and Biomimetic Membrane Devices
14.1 Introduction
14.2 Overview of Conventional Devices in the Treatment of Kidney Disease: Dialysis, Filtration, and Hemopurification
14.3 Introduction to Sorbents and Immunomodulatory Devices for AKI and Multiple Organ Dysfunction Syndrome (MODS)
14.4 Exogenous Cell-Based Devices: Renal Assist Device (RAD), Bioartificial Kidney (BAK), and Bioartificial Renal Epithelial Cell System (BRECS)
14.5 Leukocyte Processing Strategies: Selective Cytopheretic Device (SCD) in the Treatment of AKI
14.6 Beyond AKI: Potential Impact of Immunomodulatory Devices for Other Kidney-Related Diseases
14.7 Summary
References
Chapter 15: Artificial Intelligence in Nephrology
15.1 Introduction
15.2 Impact of AI on Medical Reasoning (MR) and Decision-Making (DM)
15.3 Machine Learning Techniques
15.3.1 Decision Tree
15.4 Artificial Neural Networks (ANNs)
15.5 Support Vector Machines
15.6 Clinical Applications of ANNs in Nephrology
15.6.1 Nephropathology
15.6.2 IA in Glomerulonephritis
15.6.3 Kidney Transplant
15.6.4 Acute Kidney Injury
15.6.5 Ethics and Safety in the Use of AI Technologies
References
Chapter 16: PathoSpotter: Computational Intelligence Applied to Nephropathology
16.1 Introduction
16.2 Digital × Computational Pathology
16.3 How Do Computers Find Patterns in Histology Images?
16.4 The PathoSpotter Project
16.4.1 A Map of Kidney Histological Lesions
16.4.2 A Content-Based Image Retrieval System
16.4.3 How PathoSpotter Finds Patterns in Histology Images
16.5 Achievements, Challenges, and Future Prospects
16.6 Concluding Remarks
References
Chapter 17: Internet of Things and Wearables for Kidney Diseases
17.1 Introduction
17.2 The Use of Wearables for Health Monitoring
17.3 Application of Wearables in the Context of Kidney Diseases
17.4 Conclusion
References
Chapter 18: Conversational Assistants and their Applications in Health and Nephrology
18.1 Introduction
18.2 Architecture of a Health CA
18.3 Applications of a CA
18.3.1 Health CA and its Context of Use
18.3.2 CA in the Integration of the Healthcare Team and Patients
18.3.3 CA and Design Solutions for LHL Users
18.4 Development of a Health CA for Monitoring, and its Interventions in CKD Patient Communication
18.4.1 Characterization of Dialogues for Health Treatment Monitoring
18.4.2 Definition of the Health CA Requirements
18.4.3 Modeling of the Dialogue with the Health CA in Development
18.5 Opportunities and Risks
18.5.1 Implementation of a CA and Risks of Interaction Bias
18.5.2 Content Validation and Curation Opportunities
18.6 Conclusion
References
Chapter 19: Mobile Health in Nephrology
19.1 Introduction
19.2 mHealth Apps
19.3 Apps for Kidney Healthcare
19.4 My Kidneys, My Health Handbook
19.5 My Food Coach App
19.6 H2O Overload
19.7 Fresenius myCompanion
19.8 MiKidney
19.9 Renal Health
19.10 CKD App
19.11 MultCare
19.11.1 App Characteristics for Good Effectiveness
19.11.2 Reaching People of Different Ages and Social Classes
19.11.3 Having Resources to Help Manage Various CKD Problems
19.11.4 Interactive Resources
19.11.5 Data Security and Privacy
19.12 Conclusion
References
Chapter 20: Telenephrology: A Resource for Universalizing Access to Kidney Care, Perspectives from Latin America
20.1 Introduction
20.2 Chronic Kidney Disease: A Silent Epidemic
20.3 Role of Prevention in a Renal Health Strategy
20.4 Computerization and Prevention of CKD
20.5 Telehealth in a Systemic Strategy of Network Renal Health: A Proposal Under Evaluation
20.5.1 Administrative, Technical, Legal, and Ethical Considerations on the Use of Telehealth in a Renal Health Network Strategy
20.5.2 Report of Telenephrology in a Renal Health Network Strategy. Chilean Experience
20.6 Telehealth and Telenephrology in Latin America
20.6.1 Use of Continuing Tele Education in Nephrology and Prevention of CKD in Latin America
20.6.2 PAHO and SLANH Alliance for Telematic Continuing Education in Prevention and Management of Kidney Diseases
20.6.2.1 SLANH Telematic Course on Prevention and Management of Acute Kidney Injury (AKI)
20.6.2.2 Telematic Modality Course of Prevention and Management of CKD for the First Level of Care in Latin America: PAHO/SLANH
20.6.3 Initiatives Under Development at SLANH to Promote Telehealth in Nephrology Practice
20.6.3.1 Contents of Digital Nephrology in the Training of Nephrologists in Latin America
20.6.3.2 Digital Platform for the Management of CKD in Primary Care
20.7 Telenephrology in Latin America During the COVID-19 Pandemic
20.7.1 Telenephrology in Patients with Advanced CKD Who Were Not on Dialysis During the COVID-19 Pandemic: Preliminary Report
References
Chapter 21: Innovations in Intensive Care Nephrology
21.1 Current Criteria for the Diagnosis of Acute Kidney Injury (AKI)
21.2 Innovations in Diagnosing AKI
21.2.1 Continuous GFR Monitoring [5]
21.2.2 Continuous Urine Output Monitoring
21.2.3 Clinical Applications
21.3 Innovation in AKI Biomarkers
21.3.1 Neutrophil Gelatinase-Associated Lipocalin
21.3.2 Kidney Injury Molecule-1
21.3.3 L-Type Fatty Acid Binding Protein
21.3.4 Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor-Binding Protein 7
21.4 Innovation in the Management of AKI: Role of Electronic Alerts
21.4.1 E-alerts and AKI Care Bundle
21.4.2 Pros and Cons of E-alert Systems
21.5 Innovation in Post-AKI/AKD Clinic and Role of Telemedicine
21.6 Innovation in Continuous Renal Replacement Therapy: Role of Blood Purification
21.6.1 Polymyxin B or Toraymyxin®
21.6.2 Cytosorb®
21.6.3 oXiris®
21.6.4 HA-230®, HA-280®, HA-330®, HA-380®
21.6.5 Lipopolysaccharide Adsorbers
21.6.6 Coupled Plasma Filtration Adsorption (CPFA)
References
Chapter 22: Innovations in Kidney Transplantation
22.1 Introduction
22.2 Promising Innovations in Kidney Transplantation
22.2.1 Access to Kidney Transplantation: Access to Waiting List
22.2.2 Access to Kidney Transplantation: Organ Supply and Allocation
22.2.3 Access to KT: Faster Organ Shipping
22.2.4 Access to KT: Expanding Organ Source
22.2.5 Organ Preservation
22.2.6 Immunological Evaluation
22.2.7 Transplant Surgery
22.2.8 Immunosuppression
22.2.9 Posttransplant Follow-Up and Monitoring
22.3 Conclusion and Future Perspectives
References
Chapter 23: Development and Implementation of Unmanned Aerial Vehicles for Donor Organ Transportation
23.1 Introduction
23.2 UAV Technology, Current State of the Art
23.3 Donor Organ Monitoring and Impact of Transit Conditions
23.4 Clinical Utilization
23.5 Current Limitations of UAV Implementation
23.6 Future Applications
23.7 Conclusion
References
Chapter 24: Implementation and Development of a Robotic Surgery Program
24.1 Introduction
24.2 Implementation and Development of a Robotic Surgery Program
24.2.1 Robotic Surgery Committee
24.2.2 Infrastructure
24.2.3 Training and Continuing Education
24.2.4 Robotic Team
24.2.5 Safety and Quality in Robotic Surgery
24.2.6 Robotic Surgery Department
24.2.7 Marketing and Patient Education
References
Chapter 25: Robotics and the Avant-Garde Role of Urologic Surgery
25.1 Introduction
25.2 Nephron Sparing Robotic Surgery
25.2.1 Preservation of Renal Parenchyma
25.2.2 Reduction of Warm Ischemia Time
25.3 Robotic-Assisted Kidney Transplantation
25.3.1 Surgical Technique
25.3.2 Comparison to Open Kidney Transplantation
25.3.3 Learning Curve
25.3.4 Surgical and Functional Results
25.3.5 Pediatric RAKT
25.4 Reconstructive Urology
25.4.1 Pyeloplasty
25.4.2 Ureteral Reimplantation
25.4.3 Boari Flap
25.4.4 Ureteroureterostomy
25.4.5 Buccal Ureteroplasty
25.4.6 Appendiceal Flap
25.4.7 Ileal Ureter
25.4.8 Augmentation Cystoplasty
25.4.9 Bladder Neck Reconstruction
25.5 Conclusion
References
Chapter 26: Caregiver Robots in Nephrology: Is It Feasible?
26.1 Introduction
26.1.1 From the Dawn of Humanity to Technological Evolution and Healthcare
26.1.2 Nephrology and the Specialties It Encompasses
26.2 Theoretical Input
26.2.1 Healthcare Assistance
26.2.2 Technological Breakthroughs in Education and Healthcare
26.2.3 The Use of Robotics and Robots in Healthcare
26.3 Study Objective
26.4 Method
26.5 Theoretical Reflection
26.5.1 The Use of Robots in Nephrology
26.5.2 Examples of Robots Participating in Surgeries and Those Used in Kidney Transplants
26.5.3 Caregiver Robots
26.5.4 The Nephrology Caregiver Robot (NCR) Proposal
26.6 Conclusion
References
Chapter 27: Preclinical Randomized Controlled Trials in Nephrology
27.1 Introduction
27.2 Study Design
27.3 Inclusion and Exclusion Criteria
27.4 Randomization and Blinding
27.5 Prespecifying Clinically Relevant Endpoints and Outcome Measurement
27.6 Protocol Registration
27.7 Summary
References
Chapter 28: Alternative Clinical Trial Designs for Nephrology Research
28.1 Introduction
28.2 The Conventional Approach to Clinical Trials
28.3 Alternative Trial Designs
28.3.1 Cluster RCTs
28.3.2 Master Protocols: Umbrella, Basket, and Platform Trials
28.3.3 Adaptive Trials
28.3.4 N-of-1 Trials
28.4 Digitization of Trial Conduct
28.4.1 Registry-Based Randomized Controlled Trials
28.4.2 Electronic Health Record (EHR) Embedded Randomized Controlled Trials
28.5 Consumer Engagement in Clinical Trials
28.6 Future of Nephrology Trials
References
Chapter 29: Consumer Involvement in Research and Decision-Making in Nephrology
29.1 Introduction: Consumer Involvement in Research
29.1.1 Definitions
29.1.2 Value of Consumer Involvement
29.2 Consumer Involvement in Research in Nephrology
29.3 Consumer Involvement in Nephrology Across the Research Cycle
29.3.1 Priority Setting
29.3.2 Research Design
29.3.3 Collecting Data
29.3.4 Analysing Data
29.3.5 Dissemination
29.3.6 Implementation of Findings
29.3.7 Involvement in Evaluation
29.4 Consumer Involvement and Shared Decision-Making
29.5 Consumers and Scientific Conferences
29.6 Challenges and Limitations to Consumer Involvement
29.7 Evaluation and Reporting of Patient/Consumer Involvement in Nephrology Research
29.8 Strategies for Involving Patients in Research in CKD
29.9 Stories of Involvement in Research by Consumers
29.9.1 Chandana Guha (Australia)
29.9.2 Daniel Gallego (Spain)
29.9.3 Kelly Malheiros [3]
29.10 Conclusions and Future Directions
29.11 Consumer Involvement in This Chapter
References
Chapter 30: Social Media and Interaction Between Healthcare Professionals and the Kidney Patient
30.1 Introduction
30.2 Social Media Origins
30.3 Patient Centered e-Health
30.4 Social Media as a Tool for Telehealth
30.5 Social Media Education for Patients
30.6 Conclusions
References
Chapter 31: Innovations in Nephrology Education
31.1 Introduction
31.2 The Transition from In-Person to Virtual Congresses
31.3 Massive Open Online Courses (MOOC)
31.4 Other Digital Resources
31.5 Discussion and Conclusions
References
Index