title: Juxtaglomerular apparatus hyperplasia under dual angiotensin blockade. A footprint of adequate RAS inhibition or a concern for renal fibrosis?
abstract: BACKGROUND
  Dual renin-angiotensin system blockade with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers has been advocated to minimize proteinuria. However, recent trials have questioned the renal safety of this approach. Our understanding on the molecular effects of dual blockade in humans is incomplete.
  
  
  METHODS
  We present a patient with corticoid resistant nephrotic syndrome who developed marked juxtaglomerular apparatus hyperplasia and renin expression in the context of dual angiotensin system blockade.
  
  
  CONCLUSIONS
  Although renin may have profibrotic effects mediated by (pro)renin receptor activation, this report raises questions on the potential consequences of local renin activation on chronic kidney disease in patients with dual angiotensin blockade.
authors.affiliation: Nephrology, IIS-Fundacion Jimenez-Diaz, Autonoma University Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Fernandez-Fernandez
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.forename: Carmen
authors.initials: C
authors.lastname: Gomez-Guerrero
authors.forename: Antonio
authors.initials: A
authors.lastname: Barat
authors.forename: Catalina
authors.initials: C
authors.lastname: Martín-Cleary
authors.forename: Jesús
authors.initials: J
authors.lastname: Egido
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006965:Hyperplasia; D007606:Juxtaglomerular Apparatus / Q000187:drug effects / Q000473:pathology*; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D012083:Renin / Q000096:biosynthesis; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D055815:Young Adult; D000092502:Renin Inhibitors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D012083:Renin; D000092502:Renin Inhibitors