The Management of Chronic Renal Failure: Ten Unanswered Questions

Recent advances in our understanding of the pathophysiology of experimental chronic renal failure have led to a reappraisal of available therapies. In rats, a wide range of dietary and pharmacological interventions has promised to prevent renal scarring and progressive chronic renal failure. This has prompted their use in humans on the assumption of a similar pathophysiology of renal scarring. This review examines the rationale of these interventions, their effect in experimental animals and their applicability to humans. It asks questions regarding the efficacy of 10 interventions aimed at slowing the progression of chronic renal failure in humans. LOW PROTEIN DIETS Interest in the use of a low protein diet in patients with chronic renal failure has been renewed since Brenner et al. postulated that a high protein intake accelerates kidney scarring [1]. Their hypothesis is based on observations made in a unique strain of rats (Munich-Wistar) submitted to extensive renal ablation. The adaptive changes in the remnant kidney, characterized by glomerular hypertrophy and hyperfunction (increased perfusion and filtration), precede the development of glomerular sclerosis [2]. Whether these events ar