Prevention of progression and remission/regression strategies for chronic renal disease

Chronic renal disease (CRD) represents a major health problem, whose dimension is rapidly growing. Chronic nephropathies share common pathogenic me-chanisms that contribute to renal disease progression, even independently of the original cause. Clinical studies found a significant correlation between the rate of GFR decline and both the blood pressure levels and the extent of urinary protein excretion. Antihypertensive drugs interfering with the renin-angiotensin system (RAS) decrease proteinuria and slow renal disease progression. However, the number of patients who reach end-stage renal failure despite RAS inhibitor therapy is still considerable and there is a great need to identify therapies that can arrest evolution of kidney damage. Outcome is remarkably improved when a multimodal strategy including dual RAS blockade, lipid- lowering agents, smoking cessation, and tight glucose control for diabetes is used. New drugs targeting specific determinants of progression might increase the fraction of CRD patients who reach disease remission.