[Chronic kidney disease: classification, mechanisms of progression and strategies for renoprotection].
Chronic kidney disease is a worldwide health problem. The incidence and prevalence of kidney failure is in constant increase, involving poor outcomes and high costs. The leading causes of kidney failure are type 2 diabetes and hypertension. The new initiative "Kidney Disease Improving Global Outcomes (KDIGO)" is a global public health approach to face this problem. A formal definition for chronic kidney disease and a staging of kidney diseases from kidney damage with preserved function to kidney failure, were proposed. We reviewed the main mechanisms involved in renal disease progression, with emphasis in the proteinuria and the intrarenal activation of renin angiotensin system. Moreover, the evidence in the literature of therapeutical interventions with proved efficacy in slowing the rate of reduction of renal function is discussed, particularly the optimal control of hypertension, reduction of proteinuria and renin angiotensin system blocking. Finally, we recommend a strategy for the clinical management of patients in the different stages of chronic kidney disease.
Mezzano
Sergio
S
Unidad de Nefrología, Instituto de Medicina, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile. smezzano@uach.cl
Aros
Claudio
C
D000818:Animals; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology / Q000517:prevention & control; D011507:Proteinuria / Q000150:complications; D012084:Renin-Angiotensin System; D009626:Terminology as Topic