The development and progression of chronic renal disease. Can it be prevented or attenuated?

Many forces contribute to the immutable progressive deterioration of renal diseases. This review focuses on the pernicious haemodynamic response of the kidney to an initial loss of mass. Afferent arteriolar dilatation, coupled with relative or absolute efferent arteriolar constriction, causes the hydrostatic pressure in the intervening glomerular capillaries to increase. While sustaining the glomerular filtration rate, the glomerular hypertension may ultimately scar and destroy the kidney. Experimental studies in animals persuasively argue that the high glomerular capillary pressures do indeed contribute to progressive renal damage. Whether this observation is translatable into human renal diseases is the subject of ongoing clinical investigation. The role of dietary protein restriction and converting enzyme inhibitors in reducing this glomerular hypertension and in potentially attenuating the progression of a wide range of renal diseases is also discussed.