[The concept of nephroprotection: toward preventive and curative therapies for renal sclerosis].
During the last decade, therapeutic measures based on inhibitors of the angiotensin I converting enzyme have proved to have some efficacy in the prevention of renal fibrosis. This review is devoted to new anti-fibrotic strategies aimed at inhibiting reabsorption by proximal tubule cells of filtrated proteins, preventing transdifferentiation of proximal tubule cells, inhibiting the pro-inflammatory effects of angiotensin II and endothelin, blocking TGF beta, and limiting renal ischaemia. Furthermore, experimental models and clinical reports have shown that renal fibrosis could regress, which has important therapeutic implications. The design of new preventive and curative treatments should be accompanied by the identification of urinary and serum markers of the various stages of renal fibrosis.
Ronco
Pierre
P
Unité INSERM 489 et Service de Néphrologie B, Hôpital Tenon, 4 rue de la Chine, 75020 Paris.
D000804:Angiotensin II / Q000037:antagonists & inhibitors / Q000502:physiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D015415:Biomarkers; D016232:Endothelins / Q000037:antagonists & inhibitors / Q000502:physiology; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D007668:Kidney / Q000098:blood supply / Q000187:drug effects / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D007687:Kidney Tubules, Proximal / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D051379:Mice; D023421:Models, Animal; D011507:Proteinuria / Q000378:metabolism / Q000517:prevention & control; D051381:Rats; D012598:Sclerosis; D016212:Transforming Growth Factor beta / Q000037:antagonists & inhibitors / Q000502:physiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D016232:Endothelins; D016212:Transforming Growth Factor beta; D000804:Angiotensin II