Progression, Remission and Regression of Chronic Renal Diseases

Progression to end-stage renal disease is common in chronic nephropathies, independent of the initial insult. While genetic factors may contribute to susceptibility and progression of renal disease, proteinuria has been documented as an independent predictor of outcome. Reduction of urinary protein levels by restoration of glomerular sieving function with renin-angiotensin system (RAS) blockers has been shown to limit renal function decline in individuals with non-diabetic and diabetic nephropathies to the point that remission of the disease and regression of renal lesions have been observed in experimental animals and even in humans. In animal models, regression of glomerular structural changes is associated with remodeling of glomerular architecture. This review briefly describes our understanding of the mechanism of renal disease progression, the therapeutic advantages of ameliorating glomerular sieving dysfunction and proteinuria of RAS inhibitors and how remission/regression of renal injury can be achieved with multifactorial interventions.