摘要：

A primary role for the kidney in the initiation and maintenance of has long been recognized, but the pathogenetic interactions among renal hemodynamics, hormonal and hereditary factors, and dietary intake remain enigmatic. Reduction in filtration surface area, whether acquired in the course of intrinsic or after surgical renal ablation, leads to as well as to progressive , sequellae made even more severe by dietary . Moreover, and progressive eventuate in some individuals born with a solitary kidney, as well as in those with more severe degrees of dysgenesis (ie, oligomeganephronia). is also commonly observed in certain inbred strains in which filtration surface area is congenitally deficient. Based on these and other lines of evidence reviewed herein, we postulate that a renal abnormality that contributes to in the general population is a reduced number of nephrons. The consequences of this abnormality are limitations in the ability to excrete and thus, salt-sensitive . Finally, congenital variability in filtration surface area may explain why only some, but not all, patients exposed to potentially injurious renal stimuli eventually manifest chronic . This may also account for the susceptibility of subsets of Type I and Type II diabetics to develop overt .

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