Chronic kidney disease (CKD) is one of the most common non-communicable diseases and is an important contributor to morbidity and mortality worldwide. One major factor in the development and progression of CKD is the complement system, an important part of our innate immune system. The complement system can be activated via three different pathways, and the activation pathway involved varies among different kidney diseases.
When patients with CKD reach the kidney failure stage, kidney replacement therapy must be started. Among the available kidney replacement modalities, kidney transplantation is the preferred one. However, there is a persistent need to improve the long-term outcomes.
The first part of the thesis of Firas Alkaff focuses on the involvement of the complement system, including its activation pathways, in different kidney diseases. The most important finding is that the alternative pathway plays an important role in the progression of disease in patients with proteinuric kidney diseases. With the current development of anti-complement inhibitors, inhibiting the alternative pathway may be the future therapeutic approach for preventing disease progression in these patients.
The second part of the thesis focuses on tubular injury and fibrosis in the transplanted kidney. The findings from this part support the notion that tubular injury and fibrosis are independent risk factors for the long-term outcomes of kidney transplant recipients. Further research on the development of biomarkers to detect tubular injury and fibrosis is warranted to improve the long-term outcomes of this population.
