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Renoprotection by blockade of the renin-angiotensin-aldosterone system in diabetic and non-diabetic chronic kidney disease. Specific involvement of intra-renal angiotensin-converting enzyme activity in therapy resistance?
Minerva Med. 2004 Oct; 95(5):395-409.MM

Abstract

Data of numerous clinical trials show that lowering of blood pressure is prerequisite for reducing the rate of renal function loss in chronic renal disease. There is evidence supporting that blood pressure lowering obtained by intervention in the renin-angiotensin-aldosterone system (RAAS) has an additive renoprotective effect over reduction of blood pressure alone, both in diabetic and non-diabetic renal diseases. The main evidence for renoprotective action of RAAS blockade is provided by its consistent antiproteinuric action, which cannot completely be attributed to the reduction in blood pressure. Indeed, proteinuria reduction during therapy is the single most important factor predicting the renal prognosis, independent from the class of drugs used. Yet, still patients progress to end-stage renal disease. In this review, individual differences in therapy response and possibilities to overcome therapy resistance to RAAS blockade are discussed. Experimental data from studies in rats suggest a specific involvement of intrarenal factors, particularly of preexisting renal damage and renal angiotensin-converting enzyme (ACE) activity, in therapy resistance. Identification of such factors in individual renal patients provides mechanisms by which renoprotective strategies fail to overcome therapy resistance. This prompts for a dual approach to improve renoprotection, namely unravelling these specific intrarenal mechanisms on the one hand, and development of better strategies for early detection of renal risk on the other hand.

Authors+Show Affiliations

Division of Nephrology, Department of Internal Medicine, Groningen University Medical Center, Groningen, The Netherlands. l.vogt@int.azg.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

15467515

Citation

Vogt, L, et al. "Renoprotection By Blockade of the Renin-angiotensin-aldosterone System in Diabetic and Non-diabetic Chronic Kidney Disease. Specific Involvement of Intra-renal Angiotensin-converting Enzyme Activity in Therapy Resistance?" Minerva Medica, vol. 95, no. 5, 2004, pp. 395-409.
Vogt L, Kocks MJ, Laverman GD, et al. Renoprotection by blockade of the renin-angiotensin-aldosterone system in diabetic and non-diabetic chronic kidney disease. Specific involvement of intra-renal angiotensin-converting enzyme activity in therapy resistance? Minerva Med. 2004;95(5):395-409.
Vogt, L., Kocks, M. J., Laverman, G. D., & Navis, G. (2004). Renoprotection by blockade of the renin-angiotensin-aldosterone system in diabetic and non-diabetic chronic kidney disease. Specific involvement of intra-renal angiotensin-converting enzyme activity in therapy resistance? Minerva Medica, 95(5), 395-409.
Vogt L, et al. Renoprotection By Blockade of the Renin-angiotensin-aldosterone System in Diabetic and Non-diabetic Chronic Kidney Disease. Specific Involvement of Intra-renal Angiotensin-converting Enzyme Activity in Therapy Resistance. Minerva Med. 2004;95(5):395-409. PubMed PMID: 15467515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renoprotection by blockade of the renin-angiotensin-aldosterone system in diabetic and non-diabetic chronic kidney disease. Specific involvement of intra-renal angiotensin-converting enzyme activity in therapy resistance? AU - Vogt,L, AU - Kocks,M J A, AU - Laverman,G D, AU - Navis,G, PY - 2004/10/7/pubmed PY - 2004/12/16/medline PY - 2004/10/7/entrez SP - 395 EP - 409 JF - Minerva medica JO - Minerva Med VL - 95 IS - 5 N2 - Data of numerous clinical trials show that lowering of blood pressure is prerequisite for reducing the rate of renal function loss in chronic renal disease. There is evidence supporting that blood pressure lowering obtained by intervention in the renin-angiotensin-aldosterone system (RAAS) has an additive renoprotective effect over reduction of blood pressure alone, both in diabetic and non-diabetic renal diseases. The main evidence for renoprotective action of RAAS blockade is provided by its consistent antiproteinuric action, which cannot completely be attributed to the reduction in blood pressure. Indeed, proteinuria reduction during therapy is the single most important factor predicting the renal prognosis, independent from the class of drugs used. Yet, still patients progress to end-stage renal disease. In this review, individual differences in therapy response and possibilities to overcome therapy resistance to RAAS blockade are discussed. Experimental data from studies in rats suggest a specific involvement of intrarenal factors, particularly of preexisting renal damage and renal angiotensin-converting enzyme (ACE) activity, in therapy resistance. Identification of such factors in individual renal patients provides mechanisms by which renoprotective strategies fail to overcome therapy resistance. This prompts for a dual approach to improve renoprotection, namely unravelling these specific intrarenal mechanisms on the one hand, and development of better strategies for early detection of renal risk on the other hand. SN - 0026-4806 UR - https://www.unboundmedicine.com/medline/citation/15467515/Renoprotection_by_blockade_of_the_renin_angiotensin_aldosterone_system_in_diabetic_and_non_diabetic_chronic_kidney_disease__Specific_involvement_of_intra_renal_angiotensin_converting_enzyme_activity_in_therapy_resistance L2 - http://www.diseaseinfosearch.org/result/3996 DB - PRIME DP - Unbound Medicine ER -