FACTORS AFFECTING THE RATE OF LOSS OF NEPHRONS



It has been appreciated for some time that many patients have a slow, steady decline in renal func­tion over a period of months to years . A number of pathogenetic mechanisms have been implicated in the slow decline in renal func­tion.
Continuing Primary Insult. It is often suggested that the disease initially causing the renal injury is still active and results in progressive damage. Frequently, despite the progressive loss of renal function, it is not possible to identify continued activity of the primary disease or exposure to tox­ins.

Secondary Renal Insults. In some circumstan­ces, there may be development of secondary in­sults to the kidney, and these secondary processes could account for the progression of renal insuf­ficiency. Congestive heart failure, hypercalcemia, infection, obstruction to urine flow, exposure to nephrotoxic drugs, or alterations in the extracel­lular fluid volume may result in further decreases in renal function.