title: [Nephroprotection, fact or fiction?].
abstract: Clinical studies of the last 15 years have shown the benefit of pharmacological interventions on the progression of chronic kidney disease, confirming the concept of nephroprotection. Pharmacological blockade of the renin angiotensin system remains the cornerstone of the nephroprotective treatment but the benefits and limitations are now better defined. The RAS blockers are all the more efficient than the proteinuria is abundant and nephroprotection is obtained in proportion to the reduction in proteinuria. Combinations of ACEI+ARA are not validated and their use should be considered only under the supervision of a specialist when optimal monotherapy has failed. The target blood pressure has been the subject of recent controversies, particularly in type 2 diabetic patients with nephropathy. The target should be individualized based on the main risk, renal or cardiovascular. Recent maneuvers have also shown a nephroprotective effect, including the correction of metabolic acidosis with sodium bicarbonate.
authors: Hôpitaux universitaires de Strasbourg, service de néphrologie, 67792 Strasbourg cedex, France. thierry.krummel@chru-strasbourg.fr
authors: Thierry
authors: T
authors: Krummel
authors: Anne-Laure
authors: AL
authors: Faller
authors: Dorothée
authors: D
authors: Bazin
authors: Thierry
authors: T
authors: Hannedouche
mesh_terms: D000138:Acidosis / Q000188:drug therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure; D003131:Combined Modality Therapy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D015996:Survival Rate
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D017693:Sodium Bicarbonate