Progression of chronic renal failure

Arch Intern Med. 2003 Jun 23;163(12):1417-29. 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.

Publication types

  • Review

MeSH terms

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cell Death
  • Complement Activation
  • Disease Progression
  • Hemodynamics
  • Humans
  • Hypertension / complications
  • Hypertension / therapy
  • Hypoxia
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy
  • Proteinuria / drug therapy
  • Smoking / adverse effects


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors