Mechanisms of progression of chronic renal disease.

Many patients with proteinuric chronic nephropathies progress relentlessly to end-stage renal failure (ESRF). Research in animal and human models has helped to identify the mechanisms involved in this progression and to indicate effective intervention. We review the main factors associated with the progression of chronic renal diseases including systemic and intra-glomerular hypertension, glomerular hypertrophy, proteinuria, hyperlipidemia, and intrarenal precipitation of calcium phosphate. We also describe a therapeutic strategy aimed at achieving maximal reno-protection.