title: Renin-angiotensin-aldosterone system blockade in chronic kidney disease: current strategies and a look ahead.
abstract: The Renin-Angiotensin-Aldosterone System (RAAS) is profoundly involved in the pathogenesis of renal and cardiovascular organ damage, and has been the preferred therapeutic target for renal protection for over 30 years. Monotherapy with either an Angiotensin Converting Enzime Inhibitor (ACE-I) or an Angiotensin Receptor Blocker (ARB), together with optimal blood pressure control, remains the mainstay treatment for retarding the progression toward end-stage renal disease. Combining ACE-Is and ARBs, or either one with an Aldosterone Receptor Antagonist (ARA), has been shown to provide greater albuminuria reduction, and to possibly improve renal outcome, but at an increased risk of potentially severe side effects. Moreover, combination therapy has failed to provide additional cardiovascular protection, and large prospective trials on hard renal endpoints are lacking. Therefore this treatment should, at present, be limited to selected patients with residual proteinuria and high renal risk. Future studies with novel agents, which directly act on the RAAS at multiple levels or have a more favourable side effect profile, are greatly needed to further explore and define the potential for and the limitations of profound pharmacologic RAAS inhibition.
authors.affiliation: Università degli Studi and IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.affiliation: Università degli Studi and IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bonino
authors.affiliation: Università degli Studi and IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cappadona
authors.affiliation: Università degli Studi and IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy. roberto.pontremoli@unige.it.
authors.forename: Roberto
authors.identifier: http://orcid.org/0000-0003-1238-872X
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000577:Amides / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000379:methods / Q000592:standards*; D005650:Fumarates / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006977:Hypertension, Renal / Q000451:nursing / Q000517:prevention & control; D011446:Prospective Studies; D011507:Proteinuria / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D000577:Amides; D000806:Angiotensin-Converting Enzyme Inhibitors; D005650:Fumarates; C446481:aliskiren
keywords: Hypertension; Kidney disease; Proteinuria; Renin–Angiotensin–Aldosterone system inhibitors; Treatment