Pathophysiology of Progressive Nephropathies

doi:10.1056/NEJM199811123392007

Volume 339:1448-1456		November 12, 1998		Number 20

Pathophysiology of Progressive Nephropathies

Giuseppe Remuzzi, M.D., and Tullio Bertani, M.D.

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In patients with renal diseases characterized by proteinuria,the initial insult to the kidney is usually followed by a progressivedecline in the glomerular filtration rate. This decline hasbeen thought to be due to changes in renal hemodynamics initiatedby the loss of nephrons.¹ When renal mass is reduced in rats,the remaining nephrons undergo sudden hypertrophy, with a concomitantlowering of arteriolar resistance and an increase in glomerularplasma flow.²^,³ Afferent arteriolar tone decreases more thanefferent arteriolar tone, and therefore, the hydraulic pressurein glomerular capillaries rises⁴ and the amount of filtrateformed by each nephron increases. . . . [Full Text of this Article]

Activation of Local Hormones and Inflammatory Chemokines by Filtered Protein

Evidence from Animal Studies

Evidence from Animal Models of Human Diseases

Limiting Protein Filtration

Protein-Dependent Interstitial Inflammation in Nephropathies

Ratio of Urinary Protein to Creatinine as a Predictor of End-Stage Renal Disease

Effect of Reducing Protein Excretion on the Decline in the Glomerular Filtration Rate

Role of Blood-Pressure Reduction

Conclusions

Source Information

From the Mario Negri Institute for Pharmacological Research and the Nephrology Unit, Ospedali Riuniti di Bergamo — both in Bergamo, Italy.

Address reprint requests to Dr. Remuzzi at the Mario Negri Institute for Pharmacological Research, Via Gavazzeni 11, 24125 Bergamo, Italy.

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