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 nondiabetic 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. © 2016 S. Karger AG, Basel Received: December 23, 2015 Accepted after revision: March 26, 2016 Published online: April 21, 2016 Prof. Giuseppe Remuzzi IRCCS – Istituto di Ricerche Farmacologiche ‘Mario Negri’ Clinical Research Center for Rare Diseases ‘Aldo and Cele Daccò’ Via GB Camozzi 3, Ranica, IT–24020 Bergamo (Italy) E-Mail giuseppe.remuzzi @ marionegri.it © 2016 S. Karger AG, Basel www.karger.com/nef Contribution from the Special Symposium to celebrate the contributions of David G. Warnock, MD to Academic Nephrology, The University of Alabama at Birmingham, Division of Nephrology, November