Renoprotection: One or many therapies?

Abstract

The term "renoprotection" often evokes a single image:Background. Renal disease that progresses to end-stage reangiotensin-converting enzyme (ACE) inhibition therapy nal disease (ESRD) imposes a great burden on the affected to slow the "progression of renal disease." ACE inhibiindividual and on society, which mainly bears the cost of ESRD tors certainly deserve that reputation [1]. Nevertheless, (currently more than $10 billion to treat about 333,000 patients this therapy alone rarely stops renal disease progression.annually in the U.S.). Thus, there is a great need to identify Herein, we describe a multiple-risk-factor intervention therapies that arrest the progression mechanisms common to all forms of renal disease. Progress is being made. Perhaps the strategy based on inhibiting the progression mechanisms most visible advance is the randomized controlled trials (RCT) believed to be common to most forms of progressive demonstrating the renoprotective effects of angiotensin-conrenal disease. To assist the treating physician, each interverting enzyme (ACE) inhibitors. There are also numerous vention is described in substantial practical detail and other promising renoprotective therapies. Unfortunately, testprioritized according to level of recommendation. The ing each therapy in RCT is not feasible. Thus the nephrologist incentive to use the multiple-risk-factor intervention is has two choices: restrict renoprotective therapy to those shown to be effective in RCT, or expand the use of renoprotective that each intervention is either of proven value or plausitherapies to include those that, although unproven, are plausibly effective and prudent to use. Furthermore, renal disbly effective and prudent to use. The goal of this work is ease generally progresses slowly [glomerular filtration to provide the documentation needed for the nephrologist to rate (GFR) loss of about 3 mL/min/year] [2]. Thus, even choose between these strategies. small improvements in slowing renal disease progression Methods. This work first describes the mechanisms believed can provide large benefits (Fig. 1). Our hypothesis is that to be involved in the progression of renal disease. Based largely

A Role for Uric Acid in the Progression of Renal Disease

“…Hyperuricemia is common in patients with renal disease, but it has almost never been considered a risk factor for progression (25). However, two studies have found that hyperuricemia is an independent risk factor for progression in IgA nephropathy (26,27).…”

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial

“…Quanto maior o grau de proteinúria, mais intensamente a pressão arterial deve ser reduzida 9,10 . Ainda, a utilização de inibidores da enzima conversora e dos antagonistas da angiotensina II tem um efeito protetor renal independente do seu efeito na pressão arterial 9,14,15 .…”

“…Com o número crescente de pacientes em diálise é interessante identificar, entre os hipertensos, quais evoluirão para IRCT, uma vez que, dessa maneira, poder-se-á traçar estratégias de proteção renal para reduzir a frequência dessa complicação 9,16,17 .…”

From Finland to Fatland

“…Therefore, the emphasis is very much on early intervention to decelerate the rate of decline once CRF is established. Many factors (5) are now known to influence the progression of renal decline. Some, such as gender, are not open to adjustment, whereas others, including smoking, proteinuria, and hypertension (5,6), may be modified.…”

“…Many factors (5) are now known to influence the progression of renal decline. Some, such as gender, are not open to adjustment, whereas others, including smoking, proteinuria, and hypertension (5,6), may be modified. Undoubtedly, the best evidence comes from the association between elevated BP and adverse renal outcome in both diabetic (7) and nondiabetic (8,9) patients.…”