title: Kidney failure stabilizes after an increase over 2 decades.
abstract: The level of proteinuria is one of the most important predictors for progressive renal function loss in kidney disease. Reduction of urinary protein levels by renin-angiotensin-system (RAS) inhibitors limits renal function decline in patients with non-diabetic and diabetic nephropathies to the point that remission of the disease and regression of renal lesions have been reported. The increasing use of these drugs is possibly at the basis of the stabilization of rates of new cases of kidney failure reported to the US Renal Data System after a 2-decade period of progressive increases. RAS inhibition, however, may not be effective to the same degree in all patients. For those patients who do not reach a complete remission of proteinuria, treatment procedures to implement renoprotection should include strict blood pressure control (and metabolic control in diabetics), lowering of blood lipids, and lifestyle modifications. Early intervention may be important to maximize renoprotection, especially in diabetics.
authors.affiliation: Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cravedi
authors.forename: Piero
authors.initials: P
authors.lastname: Ruggenenti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
mesh_terms: D000465:Algorithms; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D002986:Clinical Trials as Topic; D003928:Diabetic Nephropathies / Q000150:complications / Q000517:prevention & control; D004195:Disease Models, Animal; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008019:Life Style; D017410:Practice Guidelines as Topic; D011507:Proteinuria / Q000150:complications / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects; D014481:United States / Q000453:epidemiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors