Vascular homeostasis and disease progression in chronic kidney disease

Background: Vascular disease is unfortunately an asymptomatic process that is responsible for a variety of organ damages such as chronic kidney disease (CKD). Present therapeutic strategy in CKD which is usually initiated at the late stage of CKD fails to enhance renal perfusion or restore function. Objective: To summarize the mechanism of vascular homeostasis in different stages of CKD to explain the present therapeutic failure. Furthermore, the authors propose an innovative strategy to restore effectively renal perfusion and function in CKD. Results: Altered vascular homeostasis with impaired vascular repair is observed in late stage of CKD and would explain the present therapeutic failure. However, an adequate vascular repair is observed in early stage of CKD, which would provide an alternative innovative approach to restore renal function in this early stage under environment favorable for renal angiogenesis and regeneration. Conclusion: A restoration of renal perfusion and function can be accomplished in early stage of CKD with multidrug vasodilators.