Why does kidney disease progress?
Common mechanisms underlie the progression of most kidney diseases. These mechanisms initially involve adaptive changes to loss of nephrons that eventually have maladaptive consequences.
The best-described common mechanism of progression is glomerular hyperfiltration. Reductions in the nephron number cause increased filtration rate in residual nephrons—the greater the degree of nephron loss, the greater the compensatory increase in the function of the residual units.
After these initially adaptive increases in function, pathologic changes appear, ultimately resulting in glomerular sclerosis.
Other mechanisms of progression include kidney fibrosis, loss of podocytes, activation of the renin-angiotensin-aldosterone system, and proteinuria.
