PATHOPHYSIOLOGY AND MANAGEMENT OF PROGRESSIVE RENAL-DISEASE

Recently, the hypothesis that all renal diseases are inherently progre ssive and self-perpetuating has focused attention on adaptive changes in renal structure and function that occur whenever renal function is reduced. These glomerular adaptations to renal disease include increas es in filtration rate, capillary pressure and size, and are referred t o as glomerular hyperfiltration, glomerular hypertension and glomerula r hypertrophy, respectively. Extrarenal changes, such as dietary phosp hate excess, systemic hypertension, hyperlipidaemia, acidosis and hype rparathyroidism occur in animals with renal disease and may be contrib utors to progression of renal disease. Emphasis in the management of c ompanion animals with renal disease has shifted to identifying, unders tanding and controlling those processes that play a role in the progre ssion from early to end-stage renal failure. Advances made by veterina ry nephrologists in the past 15 years permit resolution of old controv ersies, formulation of new hypotheses and discussion of unresolved iss ues about the nature of progressive renal disease in dogs and cats.