Address of Corresponding Author

Kidney Blood Press Res 2005;28:230-242 (DOI: 10.1159/000087842)

  Key Words

• Renin-angiotensin-aldosterone system
• Angiotensin-converting enzyme inhibitors
• Angiotensin II receptor antagonists
• Renal failure
• Proteinuria

  Abstract

The renin-angiotensin-aldosterone system (RAAS) blockade is currently the best-documented treatment strategy to delay the progression of chronic nephropathies. Angiotensin-converting enzyme inhibitors (CEIs) or angiotensin II type 1 receptor antagonists (ARBs) should be used in every normotensive and hypertensive patient with chronic proteinuric nephropathy of both diabetic and non-diabetic origin. The therapy should be initiated as early as possible, bearing in mind that the renoprotection is more effective if used before overt proteinuria or a reduction in kidney function is present. The therapy should be offered to all patients, regardless of renal function, as well as to subjects with severely impaired glomerular filtration. CEIs and ARBs should be administered in therapeutic doses as high as possible to achieve maximal possible proteinuria reduction and systemic blood pressure target <130/80 mm Hg, and 125/75 mm Hg in those subjects with renal insufficiency who present with proteinuria above 1 g/24 h. The combined therapy with the concomitant use of CEIs and ARBs should be offered to all patients with proteinuric non-diabetic chronic nephropathies who do not achieve full and persistent remission of proteinuria with CEI or ARB alone. The article reviews an evidence-based approach on the use of RAAS-inhibiting agents in kidney diseases, considers treatment strategies in different clinical situations and discusses some perspectives related to the implementation of the RAAS blockade in renal protection.

Copyright © 2005 S. Karger AG, Basel

  Author Contacts

Leszek Tylicki, MD, PhD
Department of Nephrology, Transplantology and Internal Medicine
Medical University of Gdask
Dbinki 7 St., PL-80-211 Gdask (Poland)
Tel. + 48 58 3492505, Fax +48 58 3461186, E-Mail leszek.tylicki@amg.gda.pl

  Article Information

Published online: August 25, 2005
Number of Print Pages : 13
Number of Figures : 4, Number of Tables : 3, Number of References : 110