title: What is the role of renin inhibition in the treatment of diabetic kidney disease?
abstract: Inhibition of the renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in preventing and treating diabetic nephropathy. However, despite documented beneficial effects of RAAS inhibitors in diabetic patients with nephropathy, reversal of the progressive course of this disorder or at least long-term stabilization of renal function are often difficult to achieve, and many patients still progress to end-stage renal disease. Incomplete inhibition of the RAAS has been postulated as one of the reasons for unsatisfactory therapeutic responses to RAAS inhibition in some patients. Inhibition of renin, a rate-limiting step in the RAAS activation cascade, is the logical approach to overcome at least some of the above-mentioned problems associated with the treatment with traditional RAAS inhibitors. This article focuses on experimental and clinical studies evaluating the two principal approaches to renin inhibition: direct renin inhibition with competitive inhibitors (eg, aliskiren) and inhibition of the (pro)renin receptor.
authors: Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, OR 97239-2940, USA. komersr@ohsu.edu
authors: Radko
authors: R
authors: Komers
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D011956:Receptors, Cell Surface / Q000037:antagonists & inhibitors; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*; D000093342:Prorenin Receptor; D000092502:Renin Inhibitors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D011956:Receptors, Cell Surface; D012083:Renin; D000093342:Prorenin Receptor; D000092502:Renin Inhibitors