title: Pharmacological Effects of RAAS Blockade in Ischemic Nephropathy.
abstract: BACKGROUND
  The management of ischemic nephropathy due to atherosclerotic renal artery stenosis has become increasingly conservative in the modern era, with current guidelines recommending optimized medical therapy as the initial step. The doubts raised by the recently published trials of revascularization strategies have led to a renewed focus on pharmacological strategies promoting blood pressure control and renal protection. It is essential to further elucidate the pathophysiological mechanisms underlying hypoperfusion induced renal microvascular dysfunction with subsequent tissue injury and fibrogenesis. The role of renin angiotensin aldosterone system as a mediator of the main pathophysiological consequences of ischemic nephropathy is well known. However, more recent experimental evidence on the adrenergic system and intrarenal tubular feedback mechanisms has stimulated new interest towards a multi-target therapeutic approach.
  
  
  METHODS
  This review focuses on the pharmacology of the principle therapeutic drug classes currently used in the treatment of atherosclerotic renal artery stenosis with an analysis of their metabolic aspects and use in clinical practice based on evidence from clinical trials.
  
  
  CONCLUSIONS
  An optimal pharmacologic approach is crucial for a successful prevention of renal injury and cardiovascular events in this high-risk population. Antihypertensive treatment should include renin angiotensin aldosterone system blockade medication not only for their antihypertensive properties, but especially for those cardio and renoprotective.
authors.forename: Laura
authors.initials: L
authors.lastname: Rivoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Mario
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coppolino
authors.affiliation: Department of Clinical Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, Italy. antonietta_gigante@yahoo.it.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Gigante
authors.forename: Biagio
authors.initials: B
authors.lastname: Barbano
authors.forename: Tariq E
authors.initials: TE
authors.lastname: Farrah
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosato
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fuiano
authors.forename: Rosario
authors.initials: R
authors.lastname: Cianci
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D057912:Angiotensin II Type 2 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects*; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D012083:Renin; D000092502:Renin Inhibitors