Progression of Chronic Renal Disease

Nephron adaptation to injury:

Change in function

Beneficial Effect

Adverse effect

Ý GFR

Ý solute excretion

Accelerates glomerular injury

Ý fractional excretion of Na

Prevents Ý ECF

Slow adaptation to Na restriction

Ý PTH

ß phosphate retention

Bone disease

Ý NH3 secretion

ß systemic acidosis

Ý progression of tubulointerstitial disease

Mechanisms of injury initiation:

Mechanisms of renal disease progression

End stage renal Disease

Management of renal disease progression: