ASSESSMENT OF STRUCTURE AND FUNCTION IN PROGRESSIVE RENAL-DISEASE

The incidence and prevalence rates of end-stage renal disease (ESRD) i n the United States continue to increase. In 1995, the incidence rate was 262 per million population, with a point prevalence rate of 975 pe r million population. The exact number of individuals with abnormal re nal function but not yet at end stage is difficult to assess. Crude es timates suggest that approximately 0.4% of the U.S. population has ser um creatinine values greater than 2.0 mg/dl. In some sub-populations, such as African Americans, the estimate is+ as high as 1.0%. The rate of progression, likewise, is difficult to assess. In general. renal ma nifestations of certain systemic diseases such as diabetes mellitus an d systemic lupus erythematosus, and those with significant proteinuria (usually greater that 3.0 g/24 hr) seem to have a more rapid progress ive course to end stage. If intervention is expected to be successful in halting or slowing down progression, accurate assessment of the ear ly manifestations of renal disease, structure, and function need to be established. Currently accepted methods of assessment of renal diseas e include measurement of renal function such as serum creatinine and g lomerular filtration rate, measurement of proteinuria, assessment of t ubular function, glomerular sieving and permselectivity, radiologic im aging techniques, and evaluation of histo-morphometry. Interventions t hat have been shown to slow progression include control of hypertensio n, and treatment modalities that reduce proteinuria, such as, the use of angiotensin converting enzyme inhibitors. Further clinical and basi c science studies are needed to accurately define the important predic tors of progression, and interventions that are effective in slowing o r halting progression.