Potential methods to prevent interstitial fibrosis in renal disease

Almost all forms of end stage renal disease (ESRD) are characterised by pro gressive interstitital fibrosis and tubular atrophy. Since most forms of ch ronic renal failure are initiated by inflammatory processes, anti-inflammat ory strategies can be successful, if initiated early, in preventing progres sion of the disease process. Unfortunately, in most cases the disease is on ly detected clinically following robust progression of interstitial fibrosi s. In these patients, control of secondary risk factors, such as hypertensi on and hyperglycaemia, can slow the progression rate but cannot stop the pr ocess completely. Certainly, ACE inhibitors remain the mainstay of preservi ng renal function. However, additional therapies are needed for the effecti ve treatment of progressive renal fibrosis. A number of compounds have show n some very potent antifibrotic properties in vitro and in vivo, and are cu rrently undergoing further evaluation. This review discusses the most promi sing among them. However, few of the therapeutic agents discussed here have been tested clinically. Studies evaluating the potential of a number of th ese have just commenced whereas for many others clinical use is still many years away. However, some very promising reagents may enhance our clinical arsenal within a relatively short period of time.