Article

Can we slow the progression of chronic kidney disease?

Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
Current opinion in pediatrics (impact factor: 2.01). 04/2010; 22(2):170-5. DOI:10.1097/MOP.0b013e3283360a5c pp.170-5
Source: PubMed

ABSTRACT Childhood chronic kidney disease usually progresses towards end-stage renal failure once a critical impairment of renal function has occurred. This process is largely independent of the underlying renal disease. Recent clinical trials have provided evidence that the progressive course of chronic kidney disease can be slowed substantially by pharmacological intervention.
Hypertension and proteinuria are the most important independent risk factors for renal disease progression in both adult and pediatric nephropathies. Pharmacological blockade of the renin-angiotensin system provides efficient control of blood pressure and proteinuria, and superior long-term renoprotection compared with other antihypertensive agents. Recent pediatric evidence supports the renoprotective efficacy of tight blood pressure control aiming for the low-normal range. In addition, promising preliminary findings suggest an additional renoprotective potential by correction of metabolic acidosis and hyperuricemia and by administration of antiproliferative and antioxidative drugs.
Pharmacological renoprotection currently focuses on antihypertensive and antiproteinuric treatment by blockade of the renin-angiotensin system. Intensified blood pressure control can improve 5-year renal survival by 35% in children with chronic kidney disease. Additional complementary strategies under current clinical evaluation bear potential to improve renal survival even further.

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

5-year renal survival
 
Additional complementary strategies
 
additional renoprotective potential
 
antiproteinuric treatment
 
blood pressure
 
blood pressure control
 
chronic kidney disease
 
critical impairment
 
current clinical evaluation
 
end-stage renal failure
 
independent risk factors
 
Intensified blood pressure control
 
low-normal range
 
Recent clinical trials
 
Recent pediatric evidence
 
renal disease progression
 
renal survival
 
renin-angiotensin system
 
superior long-term renoprotection
 
underlying renal disease