The progression of chronic renal failure: a harmful quartet.

The progression of chronic renal failure (CRF) levels.2,6 In the MRFIT study, the risk of developing ESRD increased exponentially with increasing levels remains one of the main challenges in clinical neph-rology. Over the last quarter of a century, animal of blood pressure.4 Patients with underlying chronic renal disease are also at increased risk from hyper-experimentation has identified many of the pathophy-siological mechanisms underlying the associated tensive-induced renal damage. This is likely to be due to the susceptibility of their glomeruli to systemic renal scarring process. Consequently, research has implicated a wide range of mediators, including hypertension, as remnant glomeruli are poorly auto-regulated and therefore allow the unopposed trans-prominent roles for cytokines, chemokines and growth factors.1 This has suggested therapies based mission of systemic hypertension to their capillary bed.7 The ensuing glomerular capillary hypertension on the manipulation of these mediators and aimed at the prevention of progressive renal fibrosis and func-accelerates the development of glomerulosclerosis.7 Having established that systemic hypertension tional decline.1 Unfortunately, the relevance of these interventions and their applicability to patients with accelerates the progression of CRF, experimental and clinical evidence has confirmed the beneficial effect progressive renal insufficiency remain uncertain. Meanwhile, nephrologists continue to be faced with of its control on the progression of diabetic and non-diabetic nephropathies.8 However, questions have an increasing number of patients with progressive CRF. It is therefore imperative to review available been asked as to target blood pressure and the type of antihypertensive agents used. Before we examine clinical interventions based on the manipulation of known clinical risk factors for the progression of CRF. the arguments for different target blood pressures and preferential use of some antihypertensive agents, we Hypertension has been linked to the progression of chronic renal failure (CRF) since the pioneering days shall examine briefly the role of other risk factors affecting the progression of CRF that may interact of Richard Bright in the 19th century and Volhard and Farr early this century. More recently, a large with hypertension and influence its management. It has been known for many years that proteinuria body of evidence has suggested that the progression of CRF is accelerated by raised systemic blood pres-is a good predictor of progressive CRF.9 The North Italian Cooperative Study Group has recently con-sure.2,3 The Multiple Risk Factor Intervention Trial (MRFIT) identified systemic hypertension as a signific-firmed the importance of proteinuria as a poor prog-nostic factor in patients with CRF.3 …