RENAL FIBROSIS - INSIGHTS INTO PATHOGENESIS AND TREATMENT

The progression of chronic renal failure is characterised histological ly by glomerulosclerosis, tubulointerstitial fibrosis and vascular scl erosis. Recent research has identified common mechanisms underlying th ese fibrotic processes. In particular, the scarring process within the glomeruli and the tubulointerstitium involves the infiltration by inf lammatory cells including monocytes, the activation of intrinsic renal cells as well as interactions between infiltrating and resident cells . These interactions depend, to a large extent, on the release by thes e cells of chemokines, cytokines and growth factors. These factors are in turn involved in the induction of cellular proliferation within th e kidney and the stimulation of the synthesis and deposition of extrac ellular collagenous matrix. Fibrosis is believed to result from excess ive synthesis of extracellular matrix and a concommitant decrease in i ts breakdown. This fibrotic process resulting in end stage renal insuf ficiency bears strong similarities to that taking place within cirrhot ic livers or fibrotic lungs. The new insights in our understanding of renal fibrosis have opened the way to new interventions aimed at its p revention. This may ultimately slow the progression of chronic renal i nsufficiency and decrease the number of patients requiring dialysis re placement therapy. (C) 1997 Elsevier Science Ltd.