Renal therapy using tissue-engineered constructs and gene delivery

Currently available renal replacement therapies are not optimal for most pa tients. In addition to the inherent shortage of transplant organs, signific ant complications are associated with renal transplantation and immunosuppr essive therapy. Dialysis neglects the resorptive, homeostatic, metabolic, a nd endocrinologic functions of the kidney and only partially replaces its f iltration properties, resulting in morbidity and mortality. Application of tissue-engineering techniques may improve many aspects of renal function re placement. Identification of the growth factors capable of directing tissue development and of the technique to be used for their delivery would aid i n the engineering of human tissue. The combination of tissue-engineering st rategies with gene therapy might allow the transfection of diseased tissues with designated cDNA to eliminate inherent or acquired defects. Devices th at have been targeted at replacing a single aspect of renal function, in ad dition to three-dimensional renal units that are capable of excreting urine -like solutes, have been used experimentally. Combination of these strategi es may allow the formation of tissue-engineered kidneys in the future. acut e renal failure (ARF) would have a significant impact on the reduction of p atient morbidity and mortality. This article reviews the current options for renal replacement therapy, i.e ., hemodialysis, peritoneal dialysis, and transplantation, and discusses ho w tissue engineering may be applied as a means of improving current dialysi s devices and as an innovative modality for renal replacement therapy.