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June 23, 2003

Progression of Chronic Renal Failure

Author Affiliations

From the William Jennings Bryan Dorn Veterans Affairs Medical Center and the Division of Nephrology, Department of Medicine, University of South Carolina School of Medicine, Columbia. The author has no relevant financial interest in this article.

Arch Intern Med. 2003;163(12):1417-1429. doi:10.1001/archinte.163.12.1417

Chronic renal failure is characterized by a persistently abnormal glomerular filtration rate. The rate of progression varies substantially. Several morphologic features are prominent: fibrosis, loss of native renal cells, and infiltration by monocytes and/or macrophages. Mediators of the process include abnormal glomerular hemodynamics, hypoxia, proteinuria, hypertension, and several vasoactive substances (ie, cytokines and growth factors). Several predisposing host factors may also contribute to the process. Treatments to delay progression are aimed at treating the primary disease and at strictly controlling the systemic blood pressure and proteinuria. The role of antihypertensive agents, statins, and use of other maneuvers such as protein restriction and novel approaches are also discussed herein.