A reduction in which of the following parameters is the first alteration that leads to the development of chronic renal failure or end-stage renal disease?

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As chronic renal failure progresses, the glomerular filtration rate (GFR) decreases.The kidneys adapt to the decrease in GFR as a means of preserving function; however, in the long run, it results in an increased loss of nephrons.Blood pressure may be affected by these adaptations, but because blood pressure may be affected by heart and blood vessel function as well as water and electrolyte alterations, it is not specific to impaired kidney function.Left ventricular ejection reflects the strength and structure of the heart.Blood volume is not affected until the end stages of renal failure.

A Reduction in Which of the Following Parameters Is the First