Chronic kidney disease (CKD) is a worldwide public health problem that affects millions of people from all racial and ethnic groups. At end of 2013, over 300,000 Japanese patients had maintenance dialysis
therapy (JSDT). In Japan, the major causes of
end stage kidney disease (ESKD) are chronic
glomerulonephritis (particularly
IgA nephropathy), type 2
diabetic nephropathy, and hypertensive
nephrosclerosis.
Hypertension is a major factor driving the progression of CKD to ESKD. Since many features of the pathogenesis of
IgA nephropathy are still obscure, specific treatment is not yet available. However, efforts by investigators around the world have gradually clarified different aspects of the pathogenesis and treatment of
IgA nephropathy. Today, around half of all diabetic patients in Japan receive medical treatment. Type 2
diabetic nephropathy is one of the major long-term microvascular complications occurring in nearly 40% of Japanese diabetic patients. The pathogenesis of
diabetic nephropathy involves both genetic and environmental factors. However, the candidate genes related to the initiation and progression of the disorder are still obscure in patients with
diabetic nephropathy. Regarding environmental factors, the toxicity of persistent
hyperglycemia,
reactive oxygen species, systemic and/or glomerular
hypertension,
dyslipidemia and
complement are considered to play an important role. The first part of this review covers the pathogenesis of
IgA nephropathy and type 2
diabetic nephropathy, and combines the clinicopathological findings in patients with our research on the ddY and KKA-y mouse models (spontaneous animal models for
IgA nephropathy and
diabetic nephropathy, respectively). In Japan, the major
renal replacement therapies (RRT) are
peritoneal dialysis (PD) and
hemodialysis (HD). The second part of this review focuses on PD and HD. Based on our research findings from patients and as well as from animal models, we discuss strategies for the management of patients on PD and HD.