Lessa Ennis, of Austin, donated a kidney to help her step-father. But her kidney did not go to him, it went to a stranger. And that stranger's wife donated her kidney to help Lessa's step-father. This way both patients with kidney failure got a kidney from a tissue type matched living donor.
Last year 16,520 kidney transplants were performed in the United States, with 36% from living donors. But 82,500 Americans are still on the waiting list for a kidney. The Alliance for Paired Donation seeks to increase the number of living donors by pairing families according to tissue type.
Kidney failure, requiring dialysis or transplant, is often the end result of long-term kidney disease. But it doesn't have to be this way. Medical researchers are actively exploring ways to prevent and treat kidney disease. One promising area of research is renal apoptosis. A recent article in the Journal of the American Society of Nephrology reviews the progress.
Apoptosis is an active form of cell death that I like to think of as deliberate. Researchers estimate that 10 billion cells per day die from apoptosis in a healthy human, and are replaced by new cells formed by mitosis. This process of cell replacement is believed to be essential to tissue repair. The balance of mitosis and apoptosis protects our health against cancer (too much mitosis) and organ failure (too much apoptosis).
The cancer drug cisplatin has been shown to promote apoptosis in the kidneys, as we might expect. Unfortunately, other drugs also promote renal apoptosis as a side effect. Acetominophen and the aminoglycoside antibiotics can cause kidney damage by inducing too much apoptosis.
A few small molecules that inhibit apoptosis have been identified. IDN-6556 has been shown to inhibit apoptosis in the liver, and pifithrin-alpha has been used to protect kidneys used in transplants.
Molecular regulation of apoptosis shows promise for new therapies for kidney disease. For the present time, our best defense against chronic kidney disease is careful health monitoring.
Austin American-Statesman, November 2, 2009, page 1.