Mechanisms and Treatment of CKD

被引:229
作者
Ruggenenti, Piero [1 ,2 ]
Cravedi, Paolo [1 ]
Remuzzi, Giuseppe [1 ,2 ]
机构
[1] Clin Res Ctr Rare Dis, Mario Negri Inst Pharmacol Res, Ranica, Italy
[2] Azienda Osped Osped Riuniti Bergamo, Nephrol Unit, Bergamo, Italy
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2012年 / 23卷 / 12期
关键词
CHRONIC KIDNEY-DISEASE; PROGRESSIVE RENAL-DISEASE; CONVERTING-ENZYME-INHIBITION; RANDOMIZED CONTROLLED-TRIAL; URINARY PROTEIN EXCRETION; POST-HOC ANALYSIS; ANGIOTENSIN-ALDOSTERONE SYSTEM; TYPE-2; DIABETIC-NEPHROPATHY; GLOMERULAR-FILTRATION-RATE; PLACEBO-CONTROLLED TRIAL;
D O I
10.1681/ASN.2012040390
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
As CKD continues to increase worldwide, along with the demand for related life-saving therapies, the financial burden of CKD will place an increasing drain on health care systems. Experimental studies showed that glomerular capillary hypertension and impaired sieving function with consequent protein overload play a pathogenic role in the progression of CKD. Consistently, human studies show that proteinuria is an independent predictor of progression and that its reduction is renoprotective. At comparable BP control, inhibitors of the renin-angiotensin system (RAS), including angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), more effectively than non-RAS inhibitor therapy reduce proteinuria, slow progression to ESRD, and even improve the kidney function achieving disease regression in some cases. In participants with diabetes, RAS inhibitors delay the onset of microalbuminuria and its progression to macroalbuminuria, and ACE inhibitors may reduce the excess cardiovascular mortality associated with diabetic renal disease. In addition to RAS inhibitors, however, multimodal approaches including lifestyle modifications and multidrug therapy will be required in most cases to optimize control of the several risk factors for CKD and related cardiovascular morbidity. Whether novel medications may help further improve the cost-effectiveness of renoprotective interventions is a matter of investigation.
引用
收藏
页码:1917 / 1928
页数:12
相关论文
共 125 条
[11]   Myofibroblast differentiation during fibrosis: role of NAD(P)H oxidases [J].
Barnes, Jeffrey L. ;
Gorin, Yves .
KIDNEY INTERNATIONAL, 2011, 79 (09) :944-956
[12]   Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy [J].
Barnett, AH ;
Bain, SC ;
Bouter, P ;
Karlberg, B ;
Madsbad, S ;
Jervell, J ;
Mustonen, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (19) :1952-1961
[13]   Aldosterone in clinical nephrology-old hormone, new questions [J].
Becker, Gavin J. ;
Hewitson, Tim D. ;
Chrysostomou, Anastasia .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2009, 24 (08) :2316-2321
[14]   Changes in glomerular perm-selectivity induced by angiotensin II imply podocyte dysfunction and slit diaphragm protein rearrangement [J].
Benigni, A ;
Gagliardini, E ;
Remuzzi, G .
SEMINARS IN NEPHROLOGY, 2004, 24 (02) :131-140
[15]   RENAL PROTECTIVE EFFECT OF ENALAPRIL IN DIABETIC NEPHROPATHY [J].
BJORCK, S ;
MULEC, H ;
JOHNSEN, SA ;
NORDEN, G ;
AURELL, M .
BMJ-BRITISH MEDICAL JOURNAL, 1992, 304 (6823) :339-343
[16]   Antiproteinuric Effect of Chemokine C-C Motif Ligand 2 Inhibition in Subjects with Acute Proliferative Lupus Nephritis [J].
Ble, Alessandro ;
Mosca, Marta ;
Di Loreto, Giorgio ;
Guglielmotti, Angelo ;
Biondi, Giuseppe ;
Bombardieri, Stefano ;
Remuzzi, Giuseppe ;
Ruggenenti, Piero .
AMERICAN JOURNAL OF NEPHROLOGY, 2011, 34 (04) :367-372
[17]   NEPHRON ADAPTATION TO RENAL INJURY OR ABLATION [J].
BRENNER, BM .
AMERICAN JOURNAL OF PHYSIOLOGY, 1985, 249 (03) :F324-F337
[18]   Remission of renal disease: recounting the challenge, acquiring the goal [J].
Brenner, BM .
JOURNAL OF CLINICAL INVESTIGATION, 2002, 110 (12) :1753-1758
[19]   Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [J].
Brenner, BM ;
Cooper, ME ;
de Zeeuw, D ;
Keane, WF ;
Mitch, WE ;
Parving, HH ;
Remuzzi, G ;
Snapinn, SM ;
Zhang, ZX ;
Shahinfar, S .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) :861-869
[20]   Effects of combined ACE inhibitor and angiotensin II antagonist treatment in human chronic nephropathies [J].
Campbell, R ;
Sangalli, F ;
Perticucci, E ;
Aros, C ;
Viscarra, C ;
Perna, A ;
Remuzzi, A ;
Bertocchi, F ;
Fagiani, L ;
Remuzzi, G ;
Ruggenenti, P .
KIDNEY INTERNATIONAL, 2003, 63 (03) :1094-1103