Progression of renal disease: new insights into risk factors and pathomechanisms.
OBJECTIVE
Progression of renal failure, irrespective of the primary cause, is characterized by modification of renal structure, which culminates in terminal renal insufficiency. Interfering with progression continues to be a major challenge and is at the forefront of renal research. This review focuses on recent progress in the understanding of the mechanisms of progression and efforts to interfere with this process.


RESULTS
In addition to the long-known risk factors (hypertension and inadequate activation of the renin-angiotensin system), several novel risk factors and pathomechanisms, such as obesity, hyperglycemia, smoking, and several hormones, have recently been identified and investigated. Furthermore, the specific and blood pressure-independent pathogenetic roles of the sympathetic nervous system and the endothelin system in progression have been further clarified. Finally, novel animal models and techniques for studying specific aspects of progression have been developed and introduced.


CONCLUSIONS
Recently, considerable progress has been made concerning novel risk factors, understanding the underlying pathomechanisms, and interfering with the course of progression of renal diseases. Such improved insights will undoubtedly lead to new strategies in the future.
Gross
Marie-Luise
ML
Department of Pathology, University of Heidelberg, Germany.
Amann
Kerstin
K
D000818:Animals; D004195:Disease Models, Animal; D018450:Disease Progression; D006801:Humans; D051437:Renal Insufficiency / Q000503:physiopathology*; D012307:Risk Factors