Regenerative Nephrology: From Endogenous Kidney Repair to Bioengineered Organs — Current Evidence, Clinical Applications, and Future Perspectives

Abstract

The Chronic Kidney Disease (CKD) (About 850 million patients globally, Global Burden of Disease CKD Collaboration 2020) and Acute Kidney Injury (AKI) (About 13 to 15 million cases yearly, KDIGO 2024) continue to be one of the most common causes of morbidity, mortality. Conventional therapies slow disease progression or replace kidney function through dialysis and transplantation but do not restore damaged renal tissue. Regenerative nephrology has emerged as a multidisciplinary field integrating stem cell biology, developmental nephrology, tissue engineering, extracellular vesicle biology, gene editing, and precision medicine to repair or replace injured kidneys. Endogenous tubular repair, Mesenchymal Stromal Cells (MSCs), induced Pluripotent Stem Cells (iPSCs), extracellular vesicles, kidney organoids, kidney-on-chip systems, decellularized scaffolds, three-dimensional bioprinting, bioartificial and wearable kidneys, and genetically engineered xenotransplantation together define the current translational landscape. Early-phase clinical trials of MSC and extracellular-vesicle therapies show encouraging safety but inconclusive efficacy; kidney organoids and gene-editing platforms remain largely preclinical; bioartificial kidneys and pig-to-human kidney xenotransplantation have entered first-in-human feasibility studies. Major obstacles include cellular immaturity, poor vascularization, manufacturing standardization, immune compatibility, fibrosis reversal, and regulatory classification. In this review, the key principles, therapeutic potential, problems and challenges, as well as future prospects of regenerative nephrology are discussed in the context of the emerging paradigm of biological regeneration versus traditional renal replacement therapies.

Keywords: Regenerative Nephrology; Kidney Regeneration; Mesenchymal Stromal Cells; Kidney Organoids; Gene Editing; Tissue Engineering; Bioartificial Kidney; Extracellular Vesicles; Precision Medicine; Chronic Kidney Disease; Acute Kidney Injury; Xenotransplantation

Citation

Antoine Jean Zgheib. Regenerative Nephrology: From Endogenous Kidney Repair to Bioengineered Organs — Current Evidence, Clinical Applications, and Future Perspectives. wjnh.2026. i0402. https://doi.org/10.5281/zenodo.22646518