Renin-Angiotensin System and Renal Allograft Long-Term Outcome: A Review

Abstract

Recent developments in immunosuppressive therapy have reduced the loss of allografts from acute rejection, with a significant improvement in the one-year allograft survival. However, the introduction of more potent and selective new drug, had no effect on the development of chronic allograft dysfunction and the long-term outcome remains unchanged. Several and repeated different types of allograft insults such as delayed graft function, rejection episodes, drug nephrotoxicity, hypertension, dislipidemia determines a progressive damage with graft failure within a decade. There is no established maintenance immunosuppressive therapy that decreases chronic allograft dysfunction. The renin-angiotensin system is an important mediator in the pathogenesis of chronic progressive kidney diseases. Although the pathogenesis of chronic allograft nephropathy (CAN) is poorly understood, a reduced nephron function with hemodynamic changes associated with a cascade of inflammatory mediators, result in a chronic inflammatory process, progressive fibrosis and tissue remodeling. Recent evidence has shown beneficial effects of renin-angiotensin system blockade in the posttransplant with a decrease of blood pressure, proteinuria and inflammatory process.