Table 1.
Some examples of serious unmet needs in nephrology that can only be solved through a translational research approach
| Realm | Diagnosis and prognosis | Prevention | Therapy |
|---|---|---|---|
| AKI | No appropriate gold standard for diagnosis. Current definitions based on insensitive and non-specific parametres | Few resources beyond haemodynamic stability and hydration | No therapy beyond replacement of renal function. |
| CKD | No appropriate diagnostic method that may be used in routine practice to ascertain aetiology of most causes of CKD | High prevalence of CKD of unknown or unclear cause derails prevention efforts | Most conditions causing CKD lack specific pathogenesis-based therapy |
| No objective easy-to-use assay that allows early stratification based on risk of progression of CKD or complications or response to therapy for many conditions | Little understanding of causes underlying CKD hotspots | No regression-inducing therapy | |
| Little evidence to support much needed early interventions that decrease mortality or prevent progression | Non-specific nephroprotection based on 80s drugs. | ||
| No therapeutic approaches to prevent non-specific progression of non-proteinuric kidney disease | Non-specific immune suppression for autoimmune diseases | ||
| Treatment of complications of CKD begins too late: prevention needed | |||
| Implementation and public health | Worldwide most kidney diseases remain undiagnosed | Worldwide most basic preventive efforts for kidney diseases are unavailable or non-applied and this is true even for segments of society within richer countries | Even the few therapeutic options available remain out of reach for most of the world's population |
| Underlying causes of CKD hotspots unclear | Unclear causes of CKD hotspots prevent effective prevention programmes | Unclear causes of CKD hotspots prevent development of specific therapies | |
| Clinical trials | Trials on diagnosis mostly non-existent | Very few trials on prevention | Few trials in therapies compared with other specialties, methodological or design flaws frequent, underpowered in number of participants or follow-up |
| Inadequate or non-specific diagnostic criteria or risk stratification based on biomarkers or pharmacogenomic profiling for participants in clinical trials | |||
| Organ replacement | Non-specific immune suppression for transplantation | ||
| Kidneys cannot be generated in vitro |