The role of renin-angiotensin-aldosterone system in the progression of chronic kidney disease

Giuseppe Remuzzi, Norberto Perico, Manuel Macia, Piero Ruggenenti

Research output: Contribution to journalArticle

Abstract

The renin-angiotensin-aldosterone system (RAAS) is a well known regulator of blood pressure (BP) and determinant of target-organ damage. It controls fluid and electrolyte balance through coordinated effects on the heart, blood vessels, and Kidneys. Angiotensin II (AII) is the main effector of the RAAS and exerts its vasoconstrictor effect predominantly on the postglomerular arterioles, thereby increasing the glomerular hydraulic pressure and the ultrafiltration of plasma proteins, effects that may contribute to the onset and progression of chronic renal damage. AII may also directly contribute to accelerate renal damage by sustaining cell growth, inflammation, and fibrosis. Interventions that inhibit the activity of the RAAS are renoprotective and may slow or even halt the progression of chronic nephropathies. ACE inhibitors and angiotensin II receptor antagonists can be used in combination to maximize RAAS inhibition and more effectively reduce proteinuria and GFR decline in diabetic and nondiabetic renal disease. Recent evidence suggests that add-on therapy with an aldosterone antagonist may further increase renoprotection, but may also enhance the risk hyperkalemia.Maximized RAAS inhibition, combined with intensified blood pressure control (and metabolic control in diabetics) and amelioration of dyslipidemia in a multimodal approach including lifestyle modifications (Remission Clinic), may achieve remission of proteinuria and renal function stabilization in a substantial proportion of patients with proteinuric renal disease. Ongoing studies will tell whether novel drugs inhibiting the RAAS, such as the renin inhibitors or the vasopeptidase inhibitors, may offer additional benefits to those who do not respond, or only partially respond, to this multimodal regimen.

Original languageEnglish
JournalKidney International
Volume68
Issue numberSUPPL. 99
DOIs
Publication statusPublished - Dec 2005

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Renin-Angiotensin System
Chronic Renal Insufficiency
Kidney
Water-Electrolyte Balance
Proteinuria
Angiotensin II
Blood Pressure
Mineralocorticoid Receptor Antagonists
Hyperkalemia
Angiotensin Receptor Antagonists
Ultrafiltration
Arterioles
Vasoconstrictor Agents
Dyslipidemias
Angiotensin-Converting Enzyme Inhibitors
Renin
Blood Vessels
Life Style
Blood Proteins
Fibrosis

Keywords

  • Angiotensin
  • Chronic kidney disease
  • Proteinuria

ASJC Scopus subject areas

  • Nephrology

Cite this

The role of renin-angiotensin-aldosterone system in the progression of chronic kidney disease. / Remuzzi, Giuseppe; Perico, Norberto; Macia, Manuel; Ruggenenti, Piero.

In: Kidney International, Vol. 68, No. SUPPL. 99, 12.2005.

Research output: Contribution to journalArticle

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