Renal adaptations that permit "normal" function eventually fail, causing a progression toward ESRD because of

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As ESRD progresses, the GFR declines because of a continuing loss of nephrons.As nephron number decreases, there is less functional capacity within the kidney to filter blood and promote the excretion of metabolic end products.Uremia results from the inability to excrete nitrogenous waste products.Blood pressure increases as both sodium and water are retained, contributing to an increased blood volume.The filtration and exchange activities that occur within the glomerulus and tubules of the nephron continue in the functioning nephrons, but as the number declines, the dependence upon fewer nephrons places increased stress and wear on those remaining, continuing to promote the decline in nephron number.

Renal Adaptations That Permit "Normal" Function Eventually Fail, Causing a Progression