Adjuvant Role of Human Heterotopic Fetal Kidney Tissue Transplant in Reversing the Visible Parameters of Chronic Renal Diseases: A Preliminary Report of 9 Cases

Abstract

Introduction: Diabetes, hypertension, and associated disease of dyslipidemia along with high uric acid result in slow but progressive deterioration of renal function (chronic renal disease) leading to irreversibility. The only option left is dialysis/transplantation of the kidney. The basic premise of this chapter is that medical treatment supplemented with fetal renal tissue transplant (HLA-randomized) at a heterotopic site (under the axillary skin) can reverse the deterioration of the renal blood flow and renal function.

Materials and method: Eleven patients with chronic renal disease with progressive loss of urine, pedal edema and puffed face (including eyelids) specially in the morning, hypertension, dyslipidemia and uncontrolled diabetes, anorexia, anemia, etc., applied for human leukocyte antigen (HLA)-randomized fetal kidney tissue transplant at a heterotopic site (axilla) under local anesthesia.

They were treated in Bijoygarh State Hospital between 1999 and 2006 and were graded on the involvement of the renal disease as per the protocol of the National Kidney Foundation’s “K/DOQI clinical practice guidelines for chronic kidney disease.” All patients were advised with the following: (1) antihypertensive: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs), (2) insulin: soluble insulin in sliding scale, (3) diet: extra protein and salt-restricted diabetic diet, and (4) replacement of erythropoietin, calcitriol, and phosphate binders apart from aggressively combating hyperlipidemia. Two cases did not present for follow-up and were discarded from the present protocol.

Results and analysis: Nine cases were ultimately followed up in the present trial of fetal kidney tissue transplant at a heterotopic site for patients suffering from chronic kidney disease with progressive fall of glomerular filtration rate and summation of its clinical manifestation. Patients with stone, tumor (renal malignancy), were excluded from enlistment in this preliminary trial. The age of the patients varied from 39 to 61 year, mean 51.56 ± 8.4 years SD. Three patients were male and six patients were female. Three cases were suffering from stage 3, and the rest were suffering from stage 2 disease as per the guideline of the National Kidney Foundation. Treatment and follow-up for 9 months revealed good improvement in the glomerular filtration rate, correction of macroalbuminuria to microalbuminuria, and eventual improvement to normoalbuminuria level in many of them. There was also correction to normal or near-normal level of urea and creatinine in the serum possibly as a result of the fetal tissue transplant.

Discussion and conclusion: A current explanation for development of chronic renal injury is the imbalance between the injurious mechanism and its regenerative repair. Freshly collected (after due consent) and ethically permitted HLA-randomized fetal renal tissue if placed under the axilla, a heterotopic site, may reverse the process of ongoing degeneration of the kidney. This is due to the fact that fetal kidney is a rich source of renal stem cells, both mesenchymal and epithelial, and contains other progenitor and unidentified cells in its natural environment. The components and cytokine network with their intrinsic hypoantigenicity may actually reverse the disease process and actively participate in regeneration of the diseased host thus bringing it back to normal or near-normal function gradually.