Strategies to slow the progression of renal disease.

Recent multicenter clinical trials have confirmed that it is indeed possible to slow the progression of chronic renal disease in patients with diabetic and nondiabetic nephropathy. Antihypertensive therapy is particularly protective in this regard, either due to the lowering of blood pressure or, as is sometimes the case with ACE inhibition, to mechanisms independent of a systemic hemodynamic effect. Similarly, strict glycemic control has now clearly been shown to ameliorate the progression of diabetic nephropathy, while dietary protein restriction appears to have some benefit, although further studies will be required to establish this definitively. Finally, preliminary data suggest that some of these therapies may also slow progression in patients with renal transplant nephropathy, which has unfortunately become an increasingly common cause of ESRD. These encouraging results will hopefully stimulate further efforts to elucidate the mechanisms by which progression occurs, so that even better therapies can be designed.