title: Direct renin inhibition--a promising strategy for renal protection?
abstract: Activation of the renin-angiotensin-aldosterone system (RAAS) plays a key role in the progression of chronic kidney disease (CKD). RAAS inhibitors, such as angiotensin converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs), decrease the rate of progression of diabetic and non-diabetic nephropathies and are first-line therapies for CKD. Although these agents are highly effective, current therapeutic strategies are unable to sufficiently suppress the RAAS and stop CKD progression. Aliskiren, the first in a new class of RAAS-inhibiting agents (direct renin inhibitors) has been approved to treat hypertension. Aliskiren exerts renoprotective, cardioprotective, and anti-atherosclerotic effects in animal models that appear to be independent of its blood pressure lowering activity. Early clinical studies using urinary protein excretion as a marker of renal involvement suggest a possibly novel role for aliskiren in treating CKD. This review discusses the antiproteinuric efficacy and safety of aliskiren and considers the evidence for its potential renoprotection.
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland. slizak@gumed.edu.pl
authors.forename: Sławomir
authors.initials: S
authors.lastname: Lizakowski
authors.forename: Leszek
authors.initials: L
authors.lastname: Tylicki
authors.forename: Bolesław
authors.initials: B
authors.lastname: Rutkowski
mesh_terms: D000577:Amides / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D005650:Fumarates / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000473:pathology; D011507:Proteinuria / Q000150:complications / Q000188:drug therapy; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D005650:Fumarates; D012083:Renin; D000092502:Renin Inhibitors; C446481:aliskiren