Progression of glomerular diseases: risk factors and clinical overview

The great renal physiologist, Homer Smith, once wrote, “We are what we are because we have the kind of kidneys we have”. Thus, the important questions in nephrology are those which deal with a chemical milieu consistent with a high quality of life. When that milieu is optimal or tolerable, the nuances of social decisions become highly relevant. However, when that chemical milieu is suboptimal or intolerable due to declining kidney function, the actions of society become almost irrelevant to the patient except those actions directed toward making metabolic improvement possible.