Tubular Hypermetabolism as a Factor in the Progression of Chronic Renal Failure

I N RECENT YEARS, there has been considerable interest and new knowledge about glomerular factors that may determine the progression of chronic renal failure (CRF) and glomerular sclerosis. 1 However, there has been less focus on the potential tubular factors that may contribute to the inexorable progression of CRF once a critical level of renal functional impairment has been reached. The purpose of the present editorial is to present a hypothesis whereby hypermetabolism in tubules of surviving nephrons is proposed to be an important determinant of progression to CRF in spite of no further additional external insult to kidney function. The importance of defining the glomerular and tubular factors involved in the progression to end-stage renal disease (ESRD) is highlighted by the financial, social, and emotional cost of renal replacement therapy.2.3 Without understanding these glomerular and tubular factors, it will be difficult to design strategies that will effectively prevent progression to ESRD, thus avoiding or diminishing the need for chronic dialysis and kidney transplantation.