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Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?
Curr Opin Nephrol Hypertens. 2008 Sep; 17(5):443-9.CO

Abstract

PURPOSE OF REVIEW

The aim of this article is to review the pertinent physiology and pathophysiology of the renin-angiotensin-aldosterone system (RAAS), summarize the proven beneficial cardiovascular and renal effects of RAAS blockade, examine clinical situations in which RAAS blockade may induce reductions in glomerular filtration rate, and explore why increases in serum creatinine in the setting of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy do not necessarily signify the presence of clinically relevant kidney failure.

RECENT FINDINGS

RAAS inhibition appears to reduce the likelihood of atrial fibrillation. RAAS inhibition leads to improved insulin sensitivity and glycemic control, but does not appear to prevent diabetes. The beneficial effects of ACEi/ARB therapy extend to those with significant renal disease. Combination ACEi/ARB is safe, and reduces proteinuria more than either agent alone in patients with macroalbuminuric nephropathy. Acute deteriorations in renal function that result from RAAS inhibition are usually reversible.

SUMMARY

RAAS blockade exerts potent hemodynamic, antihypertensive, and antiinflammatory effects, and slows progression of kidney disease beyond that due to lowering of blood pressure. The benefit extends to those with advanced disease. In spite of established benefit, ACEi and ARB therapy remains underutilized, in part due to concerns about acute deteriorations in renal function that result from interruption of the RAAS.

Authors+Show Affiliations

University of Washington, Seattle, WA 98104, USA. mjryan@u.washington.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18695383

Citation

Ryan, Michael J., and Katherine R. Tuttle. "Elevations in Serum Creatinine With RAAS Blockade: Why Isn't It a Sign of Kidney Injury?" Current Opinion in Nephrology and Hypertension, vol. 17, no. 5, 2008, pp. 443-9.
Ryan MJ, Tuttle KR. Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury? Curr Opin Nephrol Hypertens. 2008;17(5):443-9.
Ryan, M. J., & Tuttle, K. R. (2008). Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury? Current Opinion in Nephrology and Hypertension, 17(5), 443-9. https://doi.org/10.1097/MNH.0b013e32830a9606
Ryan MJ, Tuttle KR. Elevations in Serum Creatinine With RAAS Blockade: Why Isn't It a Sign of Kidney Injury. Curr Opin Nephrol Hypertens. 2008;17(5):443-9. PubMed PMID: 18695383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury? AU - Ryan,Michael J, AU - Tuttle,Katherine R, PY - 2008/8/13/pubmed PY - 2009/1/7/medline PY - 2008/8/13/entrez SP - 443 EP - 9 JF - Current opinion in nephrology and hypertension JO - Curr Opin Nephrol Hypertens VL - 17 IS - 5 N2 - PURPOSE OF REVIEW: The aim of this article is to review the pertinent physiology and pathophysiology of the renin-angiotensin-aldosterone system (RAAS), summarize the proven beneficial cardiovascular and renal effects of RAAS blockade, examine clinical situations in which RAAS blockade may induce reductions in glomerular filtration rate, and explore why increases in serum creatinine in the setting of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy do not necessarily signify the presence of clinically relevant kidney failure. RECENT FINDINGS: RAAS inhibition appears to reduce the likelihood of atrial fibrillation. RAAS inhibition leads to improved insulin sensitivity and glycemic control, but does not appear to prevent diabetes. The beneficial effects of ACEi/ARB therapy extend to those with significant renal disease. Combination ACEi/ARB is safe, and reduces proteinuria more than either agent alone in patients with macroalbuminuric nephropathy. Acute deteriorations in renal function that result from RAAS inhibition are usually reversible. SUMMARY: RAAS blockade exerts potent hemodynamic, antihypertensive, and antiinflammatory effects, and slows progression of kidney disease beyond that due to lowering of blood pressure. The benefit extends to those with advanced disease. In spite of established benefit, ACEi and ARB therapy remains underutilized, in part due to concerns about acute deteriorations in renal function that result from interruption of the RAAS. SN - 1062-4821 UR - https://www.unboundmedicine.com/medline/citation/18695383/Elevations_in_serum_creatinine_with_RAAS_blockade:_why_isn't_it_a_sign_of_kidney_injury L2 - https://doi.org/10.1097/MNH.0b013e32830a9606 DB - PRIME DP - Unbound Medicine ER -