[Progression of chronic renal failure. Pathogenesis and therapeutic aspects]

Once established, chronic renal failure does not progress only when the specific triggering metabolic, immunological or vascular-renal underlying disease persists. Unspecific factors also cause progression of chronic renal failure when the underlying renal disease is no longer active or has been successfully treated. Today, such unspecific progression factors are considered to be glomerular capillary hyperfiltration/hyperperfusion, the effects of angiotensin II, uremic-associated lipid metabolic disorder, hyperphosphatemia or secondary hyperparathyroidism, as also the effect of glucocorticoids. For therapy, apart from adequate antihypertensive management, a low-protein diet and treatment of the lipid metabolic disorder and the secondary hyperphosphatemia, is recommended in the patient with chronic renal disease.