A New Therapeutic Paradigm for Chronic Kidney Disease

Professor Prasit Futrakul, MD. Professor.1
Dr. Narisa Futrakul, MD, Ph.D.2

1Fellow of The Royal Institute, Academy of Science.
2Department of Physiology, King Chulalongkorn 
Memorial Hospital, Bangkok.


Chronic kidney disease is underrecognized worldwide. This is mainly due to the lack of sensitivity of present diagnostic markers in common medical practice, such as serum creatinine, and microalbuminuria which usually detect late stage chronic kidney disease (actual creatinine clearance less than 60 ml/min/1.73m2) but are unable to screen for early stage chronic kidney disease (actual creatinine clearance over 60 ml/min/1.73m2 insensitiveness of the present diagnostic markers unrecognizes the pres ence of underlying early stage of chronic kidney disease, and usually allow the dis eased stage to slowly progress towards late stage, without any appropriate therapeutic intervention. It is very unfortunate for the patient to generally receive treatment at the late stage of chronic kidney disease, since it has recently been demonstrated that the hanism of vascular repair is markedly impaired at the late stage. Therefore, it is not surprising to realize the progressive increment in number of chronic kidney disease patients entering end-stage renal disease, which is a growing public health threat. 

In contrast to the present therapeutic failure observed in late stage chronic kidney disease, we have recently demonstrated that the mechanism of vascular repair for renal regeneration appears to function (adequately) at the early stage of chronic kidney disease. Treatment initiated at the early stage of chronic kidney disease can improve renal perfusion, with clinical impact on the restoration of renal function, since integrity of renal structure and function is modulated by renal perfusion. 

In accordance with the preceding information, a new therapeutic paradigm to effectively prevent end-stage renal disease can be implemented by (1) all physicians to discard the old conceptual view attached to low sensitivity diagnostic markers, and to treatment at late stage of chronic kidney disease, and change to a new therapeutic paradigm at the early stage of chronic kidney disease by using a new sensitive diagnostic marker such as fractional excretion of magnesium (FE Mg) (2) appropriate treatment to improve renal perfusion by correcting the hemodynamic maladjustment which is the crucial determinant inducing renal disease progression, 

Key words: chronic kidney disease, vascular repair, renai regeneration, hemodynamic