The pathogenesis of progressive renal failure

All glomerular kidney disorders with the exception of minimal change disease are characterized by a progressive decline of renal function in association with progressive glomerulosclerosis and tubulointerstitial fibrosis of the kidneys involved. This almost universal association seems to suggest that the progressive loss of kidney function results from a fibrogenic pathogenetic mechanism that serves as a final common pathway with the initial insult to the glomerulus initiating a cascade of events including an early inflammatory phase followed by a fibrogenic response in the glomerular and the tubulointerstitial compartments of the kidneys. The present review will address the pathogenesis of this fibrogenic process covering the interplay between glomerular and tubulointerstitial events, the roles of recruited and resistant cells, cytokines, growth factors and the extracellular matrix.