Progression to renal failure

Chronic renal failure is characterized by a persistently abnormal glomerular filtration rate. It represents a developing process that is initiated by various causes, all with the common end result of persistent and usually progressive damage of varying severity to the kidneys. Although the causes and the locations of renal insult may vary, many features are common in progression to renal failure, and the final histological picture is one of glomerulosclerosis, interstitial fibrosis and loss of renal cells, mainly by apoptosis. The rate of progression varies significantly. However, individual genetic variations and disease-specific mechanisms contribute to the variability in rates of progression and response to therapy. Possible mechanisms of progressive renal damage include hemodynamic factors, hypertension, proteinuria, angiotensin II, and other chemical mediators such as cytokines and growth factors. Processes and predictive factors of progression to renal failure are discussed here along with clinical practice guidelines: Evaluation, Classification and Stratification. Prevention of the progression is also briefly mentioned.