Development and progression of chronic renal disease: can it be prevented or attenuated?

Following its initiation, renal disease tends to progress relentlessly to end stage, necessitating dialysis or transplantation or causing death. Studies have shown that metabolic, hematologic and hemodynamic adaptations by the damaged kidney underlie the progressive nature of the disease. This review underscores the hemodynamic maladaptations and consequences and the evidence that suggests that glomerular hypertension is a necessary accompaniment to renal damage. The evidence reviewed indicates that high pressure develops in fragile glomerular capillaries after loss of a critical amount of renal mass and causes progressive sclerosis and destruction of remaining nephrons. This maladaptive renal response ensures progressive destruction in a variety of renal diseases including diabetes mellitus. Reduced protein intake and converting enzyme inhibitor therapy may prevent or attenuate the progression of these diseases.