Renal Nano-drug delivery for acute kidney Injury: Current status and future perspectives.

Acute kidney injury (AKI) causes considerable morbidity and mortality, particularly in the case of post-cardiac infarction or kidney transplantation; however, the site-specific accumulation of small molecule reno-protective agents for AKI has often proved ineffective due to dynamic fluid and solute excretion and non-selectivity, which impedes therapeutic efficacy. This article reviews the current status and future trajectories of renal nanomedicine research for AKI management from pharmacological and clinical perspectives, with a particular focus on appraising nanosized drug carrier (NDC) use for the delivery of reno-protective agents of different pharmacological classes and the effectiveness of NDCs in improving renal tissue targeting selectivity and efficacy of said agents. This review reveals the critical shift in the role of the small molecule reno-protective agents in AKI pharmacotherapy - from prophylaxis to treatment - when using NDCs for delivery to the kidney. We also highlight the need to identify the accumulation sites of NDCs carrying reno-protective agents in renal tissues during in vivo assessments and detail the less-explored pharmacological classes of reno-protective agents whose efficacies may be improved via NDC-based delivery. We conclude the paper by outlining the challenges and future perspectives of NDC-based reno-protective agent delivery for better clinical management of AKI. Nanosized drug carrier (NDC) – based targeting of small molecular reno-protective agents (SMRA) to kidneys with acute injury were increasingly attempted and reported effective in vivo. This review critically appraised such in vivo reports and (i) uncovered the advantageous transition in the role of SMRA in managing acute kidney injury (AKI) from prophylaxis-orientated to therapeutic orientated (outer ring) when they are delivered to the kidney by the NDCs; and (ii) highlights the less-explored pharmacological classes of SMRA (middle ring) whose efficacies may be improved via NDC-based renal drug delivery. (* outer ring : intended use of NDC-SMRA for AKI, middle ring : SMRA of various pharmacological classes integrated into NDCs and tested in vivo). [Display omitted] [ABSTRACT FROM AUTHOR]