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Renin-angiotensin-aldosterone system blockade for nephroprotection: current evidence and future directions.
J Nephrol. 2012 Nov-Dec; 25(6):900-10.JN

Abstract

Renin-angiotensin-aldosterone system (RAAS) blockade is currently the best-documented treatment strategy to delay the progression of chronic proteinuric nephropathies. Several large randomized controlled trials have shown the renoprotective potential of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in nephropathies of almost any etiology. Mineralocorticoid receptor antagonists and the direct renin inhibitor aliskiren as add-on treatments to standard therapy including the optimal dose of ACEIs or ARBs reduce albuminuria or proteinuria and retard development of renal dysfunction more than placebo. No clinical evidence is available, however, about whether these strategies may influence long-term kidney disease outcomes. Combined RAAS blockade may be offered only to patients with proteinuric chronic nephropathies who do not achieve full and persistent remission of proteinuria with ACEI or ARB alone. They need to be carefully monitored for hyperkalemia and worsening of kidney function. This article reviews an evidence-based approach to use of RAAS-inhibiting agents in kidney diseases, considers combination RAAS blockade treatment strategies and discusses some perspectives related to the implementation of RAAS blockade in renal protection.

Authors+Show Affiliations

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland. leszek.tylicki@gumed.edu.plNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22684647

Citation

Tylicki, Leszek, et al. "Renin-angiotensin-aldosterone System Blockade for Nephroprotection: Current Evidence and Future Directions." Journal of Nephrology, vol. 25, no. 6, 2012, pp. 900-10.
Tylicki L, Lizakowski S, Rutkowski B. Renin-angiotensin-aldosterone system blockade for nephroprotection: current evidence and future directions. J Nephrol. 2012;25(6):900-10.
Tylicki, L., Lizakowski, S., & Rutkowski, B. (2012). Renin-angiotensin-aldosterone system blockade for nephroprotection: current evidence and future directions. Journal of Nephrology, 25(6), 900-10. https://doi.org/10.5301/jn.5000134
Tylicki L, Lizakowski S, Rutkowski B. Renin-angiotensin-aldosterone System Blockade for Nephroprotection: Current Evidence and Future Directions. J Nephrol. 2012 Nov-Dec;25(6):900-10. PubMed PMID: 22684647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renin-angiotensin-aldosterone system blockade for nephroprotection: current evidence and future directions. AU - Tylicki,Leszek, AU - Lizakowski,Slawomir, AU - Rutkowski,Boleslaw, PY - 2012/02/13/accepted PY - 2012/6/12/entrez PY - 2012/6/12/pubmed PY - 2013/5/7/medline SP - 900 EP - 10 JF - Journal of nephrology JO - J Nephrol VL - 25 IS - 6 N2 - Renin-angiotensin-aldosterone system (RAAS) blockade is currently the best-documented treatment strategy to delay the progression of chronic proteinuric nephropathies. Several large randomized controlled trials have shown the renoprotective potential of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in nephropathies of almost any etiology. Mineralocorticoid receptor antagonists and the direct renin inhibitor aliskiren as add-on treatments to standard therapy including the optimal dose of ACEIs or ARBs reduce albuminuria or proteinuria and retard development of renal dysfunction more than placebo. No clinical evidence is available, however, about whether these strategies may influence long-term kidney disease outcomes. Combined RAAS blockade may be offered only to patients with proteinuric chronic nephropathies who do not achieve full and persistent remission of proteinuria with ACEI or ARB alone. They need to be carefully monitored for hyperkalemia and worsening of kidney function. This article reviews an evidence-based approach to use of RAAS-inhibiting agents in kidney diseases, considers combination RAAS blockade treatment strategies and discusses some perspectives related to the implementation of RAAS blockade in renal protection. SN - 1724-6059 UR - https://www.unboundmedicine.com/medline/citation/22684647/Renin_angiotensin_aldosterone_system_blockade_for_nephroprotection:_current_evidence_and_future_directions_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=22684647.ui DB - PRIME DP - Unbound Medicine ER -