Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Rethinking progression of CKD as a process of punctuated equilibrium

Nature Reviews Nephrology volume 14, pages 411–412 (2018)Cite this article

Subjects

Although most nephrologists spend their days managing patients with acute and chronic kidney disease (CKD), it is useful to occasionally consider the landscape of our current treatment approach. Here, we present the hypothesis that the major mechanisms that drive CKD are changing and will necessitate new approaches to manage this disease.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Patterns of CKD progression.

References

  1. Mitch, W. E., Walser, M., Buffington, G. A. & Lemann, J. Jr. A simple method of estimating progression of chronic renal failure. Lancet 2, 1326–1328 (1976).

    Article  PubMed  CAS  Google Scholar 

  2. Mogensen, C. E., Christensen, C. K. & Vittinghus, E. The stages in diabetic renal disease. With emphasis on the stage of incipient diabetic nephropathy. Diabetes 32 (Suppl. 2), 64–78 (1983).

    Article  PubMed  Google Scholar 

  3. Polonia, J., Azevedo, A., Monte, M., Silva, J. A. & Bertoquini, S. Annual deterioration of renal function in hypertensive patients with and without diabetes. Vasc. Health Risk Manag. 13, 231–237 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Perera, G. A. Hypertensive vascular disease; description and natural history. J. Chron. Dis. 1, 33–42 (1955).

    Article  PubMed  CAS  Google Scholar 

  5. Eldredge, N. & Gould, S. J. in Models in Paleobiology (ed. Schopf, T. J. M.) 82–115 (Cooper and Co., 1972).

  6. Stevens, P. E., Levin, A. & Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann. Intern. Med. 158, 825–830 (2013).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Research conducted in the authors’ laboratories is funded by grants from FONACYT, Venezuela (FC-2005000283, to BR-I) and Asociación de Amigos del Riñón (to BR-I) and by the National Institutes of Health NIDDK Institute (1RO1DK109408-01A1 and R01 DK108859-01).

Author information

Authors and Affiliations

  1. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Richard J. Johnson

  2. Nephrology Service Hospital Universitario, Universidad del Zulia, Instituto Venezolano de Investigaciones Científicas (IVIC-Zulia), Maracaibo, Venezuela

    Bernardo Rodriguez-Iturbe

Authors
  1. Richard J. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernardo Rodriguez-Iturbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard J. Johnson.

Ethics declarations

Competing interests

R.J.J. is on the Scientific Board of XORT Therapeutics, has patent and patent applications related to lowering uric acid or blocking fructose metabolism in the treatment of hypertension and metabolic disorders, and is a member of Colorado Research Partners, LLC, which is developing inhibitors of fructose metabolism. B.R.I. declares no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johnson, R.J., Rodriguez-Iturbe, B. Rethinking progression of CKD as a process of punctuated equilibrium. Nat Rev Nephrol 14, 411–412 (2018). https://doi.org/10.1038/s41581-018-0016-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41581-018-0016-4

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing