**1. Introduction**

12 Chronic Kidney Disease

[59] Lu, G.Y., et al., *Significance of plasma von Willebrand factor level and von Willebrand factor-*

[60] Roemer, A., et al., *Increased mRNA expression of ADAMs in renal cell carcinoma and their association with clinical outcome.* Oncology reports, 2004. 11(2): p. 529-36. [61] Doberstein, K., J. Pfeilschifter, and P. Gutwein, *The transcription factor PAX2 regulates ADAM10 expression in renal cell carcinoma.* Carcinogenesis, 2011. 32(11): p. 1713-23. [62] Fritzsche, F.R., et al., *ADAM9 is highly expressed in renal cell cancer and is associated with* 

[63] Schafer, B., et al., *Distinct ADAM metalloproteinases regulate G protein-coupled receptor-*

[64] Franovic, A., et al., *Multiple acquired renal carcinoma tumor capabilities abolished upon* 

*silencing of ADAM17.* Cancer research, 2006. 66(16): p. 8083-90.

*induced cell proliferation and survival.* The Journal of biological chemistry, 2004.

journal, 2008. 121(2): p. 133-6.

279(46): p. 47929-38.

*tumour progression.* BMC cancer, 2008. 8: p. 179.

*cleaving protease activity in patients with chronic renal diseases.* Chinese medical

Nearly ten years ago Nephrologists began using asystem of classification for chronic kidney disease (CKD). This was established in 2002 by the Kidney Disease Outcome Quality Initiative (KDOQI) to estimate kidney function in a given patient regardless of the etiology of the primary insult to the kidneys. Physicians were able place their patients in stages from mild disease to end stage renal disease (ESRD).CKD is defined as glomerular filtration rate (GFR) below 60 ml/min per 1.73 m2 for 3 months or more.

Each stage served as a "mile marker" on life's road for the patient with CKD. The natural history of CKD usually is a steady decline in kidney function, as found in the relationship between the reciprocal of serum creatinine values and time. A percentage of patients do not follow this linear pattern, suggesting either worsening or improvement in their kidney function. Factors which may cause worsening of CKD in such individuals are often infections, dehydration, poor control of systemic blood pressure and exposure to nephrotoxins, in particular nonsteroidal anti-inflamatorydrugs and radiocontrast agents. Other individuals who do not follow the steady decline may actually show improvement in their GFR. The potential to improve the natural history of CKD is through tight blood pressure control and inhibition of rennin-angiotensin-aldosterone system.
