The burden of acute and chronic kidney diseases to the health care system is exacerbated by the high mortality that this disease carries paired with the still limited availability of comprehensive therapies. A reason partially resides in the complexity of the kidney, with multiple potential target cell types and a complex structural environment that complicate strategies to protect and recover renal function after injury. Management of both acute and chronic renal disease, irrespective of the cause, are mainly focused on supportive treatments and renal replacement strategies when needed. Emerging preclinical evidence supports the feasibility of drug delivery technology for the kidney, and recent studies have contributed to building a robust catalog of peptides, proteins, nanoparticles, liposomes, extracellular vesicles, and other carriers that may be fused to therapeutic peptides, proteins, nucleic acids, or small molecule drugs. These fusions can display a precise renal uptake, an enhanced circulating time, and a directed intraorgan biodistribution while protecting their cargo to improve therapeutic efficacy. However, several hurdles that slow the transition towards clinical applications are still in the way, such as solubility, toxicity, and sub-optimal renal targeting. This review will discuss the feasibility and current limitations of drug delivery technologies for the treatment of renal disease, offering an update on their potential and the future directions of these promising strategies.

中文翻译：

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肾脏疾病的新型药物输送技术和靶点

急性和慢性肾脏疾病的高死亡率加上综合疗法的可用性仍然有限，加剧了医疗保健系统的负担。部分原因在于肾脏的复杂性，具有多种潜在的靶细胞类型和复杂的结构环境，使损伤后保护和恢复肾功能的策略变得复杂。急性和慢性肾脏疾病的治疗，无论病因如何，主要集中在需要时的支持治疗和肾脏替代策略。新出现的临床前证据支持肾脏药物输送技术的可行性，最近的研究有助于建立一个强大的肽、蛋白质、纳米粒子、脂质体、细胞外囊泡和其他可与治疗性肽、蛋白质、核酸融合的载体的目录。酸或小分子药物。这些融合可以表现出精确的肾脏摄取、延长的循环时间和定向的器官内生物分布，同时保护其货物以提高治疗效果。然而，阻碍向临床应用过渡的几个障碍仍然存在，例如溶解度、毒性和次优的肾靶向性。本综述将讨论用于治疗肾脏疾病的药物输送技术的可行性和当前局限性，提供有关其潜力和这些有前景策略的未来方向的最新信息。