Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
Erweiterte Suche
Anmelden
nach oben
Current Hypertension Reports
Erschienen in: Current Hypertension Reports 9/2017

01.09.2017 | Hypertension and the Kidney (RM Carey, Section Editor)

Effects of RAAS Inhibitors in Patients with Kidney Disease

verfasst von: Fan Zhang, Hong Liu, Di Liu, Yexin Liu, Huiqiong Li, Xia Tan, Fuyou Liu, Youming Peng, Hongqing Zhang

Erschienen in: Current Hypertension Reports | Ausgabe 9/2017

Einloggen, um Zugang zu erhalten

Abstract

Proteinuria and decline of renal function are associated with progression of kidney disease. The Renin Angiotensin Aldosterone System (RAAS) plays an important role in blood pressure regulation, fluid volume, and sodium balance. Overactivity of RAAS contributes to the pathogenesis of a variety of clinical conditions including progress of chronic kidney disease (CKD). This review summarizes the use of RAAS inhibitors as dual therapy or monotherapy in different stages of kidney disease. Experimental and clinical studies have demonstrated RAAS inhibitors prevent proteinuria, kidney fibrosis and slow decline of renal function and thus play a protective role in both early and end stages of kidney disease. While combination use of RAAS inhibitors showed higher efficiency compared with monotherapy, it is also associated with higher incidence of adverse events. Besides ACEI/ARBs, more mechanism research of mineralocorticoid receptor antagonists in kidney disease should be performed.
Literatur
1.
Guney I, Selcuk NY, Altintepe L, Atalay H, Başarali MK, Büyükbaş S. Antifibrotic effects of aldosterone receptor blocker (spironolactone) in patients with chronic kidney disease. Ren Fail. 2009;31(9):779–84.CrossRefPubMed
2.
Kaji K, Yoshiji H, Ikenaka Y, Noguchi R, Aihara Y, Shirai Y, et al. Possible involvement of angiogenesis in chronic liver diseases: interaction among renin-angiotensin-aldosterone system, insulin resistance and oxidative stress. Curr Med Chem. 2012;19(12):1889–98.CrossRefPubMed
3.
Persson F, Rossing P, Schjoedt KJ, Juhl T, Tarnow L, Stehouwer CD, et al. Time course of the antiproteinuric and antihypertensive effects of direct renin inhibition in type 2 diabetes. Kidney Int. 2008;73(12):1419–25.CrossRefPubMed
4.
Feldman DL, Jin L, Xuan H, Contrepas A, Zhou Y, Webb RL, et al. Effects of aliskiren on blood pressure, albuminuria, and (pro)renin receptor expression in diabetic TG(mRen-2)27 rats. Hypertension. 2008;52(1):130–6.CrossRefPubMed
5.
Kelly DJ, Zhang Y, Moe G, Naik G, Gilbert RE. Aliskiren, a novel renin inhibitor, is renoprotective in a model of advanced diabetic nephropathy in rats. Diabetologia. 2007;50(11):2398–404.CrossRefPubMed
6.
•• Bomback AS, Klemmer PJ. The incidence and implications of aldosterone breakthrough. Nat Clin Pract Nephrol. 2007;3(9):486–92. The "aldosterone escape phenomenon” which is the basis of a combination of RAAS inhibitors and residual renal function, protected with RAAS inhibitors, plays an important role in preservation of survival and quality of life of ESRD patients.CrossRefPubMed
7.
•• Struthers AD. Aldosterone escape during angiotensin-converting enzyme inhibitor therapy in chronic heart failure. J Card Fail. 1996;2(1):47–54 (see comment above).CrossRefPubMed
8.
Cao Z, Bonnet F, Davis B, Allen TJ, Cooper ME. Additive hypotensive and anti-albuminuric effects of angiotensin-converting enzyme inhibition and angiotensin receptor antagonism in diabetic spontaneously hypertensive rats. Clin Sci (Lond). 2001;100(6):591–9.CrossRef
9.
Wilkinson-Berka JL, Gibbs NJ, Cooper ME, Skinner SL, Kelly DJ. Renoprotective and anti-hypertensive effects of combined valsartan and perindopril in progressive diabetic nephropathy in the transgenic (mRen-2)27 rat. Nephrol Dial Transplant. 2001;16(7):1343–9.CrossRefPubMed
10.
Mehdi UF, Adams-Huet B, Raskin P, Vega GL, Toto RD. Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximal angiotensin-converting enzyme inhibition in diabetic nephropathy. J Am Soc Nephrol. 2009;20(12):2641–50.CrossRefPubMedPubMedCentral
11.
Chrysostomou A, Becker G. Spironolactone in addition to ACE inhibition to reduce proteinuria in patients with chronic renal disease. N Engl J Med. 2001;345(12):925–6.CrossRefPubMed
12.
Saklayen MG, Gyebi LK, Tasosa J, Yap J. Effects of additive therapy with spironolactone on proteinuria in diabetic patients already on ACE inhibitor or ARB therapy: results of a randomized, placebo-controlled, double-blind, crossover trial. J Investig Med. 2008;56(4):714–9.CrossRefPubMed
13.
Epstein M, Williams GH, Weinberger M, Lewin A, Krause S, Mukherjee R, et al. Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2006;1(5):940–51.CrossRefPubMed
14.
Kato S, Maruyama S, Makino H, Wada J, Ogawa D, Uzu T, et al. Anti-albuminuric effects of spironolactone in patients with type 2 diabetic nephropathy: a multicenter, randomized clinical trial. Clin Exp Nephrol. 2015;19(6):1098–106.CrossRefPubMedPubMedCentral
15.
Obata J, Nakamura T, Kuroyanagi R, Yoshida Y, Guo DF, Inagami T. Candesartan prevents the progression of glomerulosclerosis in genetic hypertensive rats. Kidney Int Suppl. 1997;63:S229–31.PubMed
16.
Wang H, Fu W, Jin Z, Wang Y, Yao W, Yin P, et al. Advanced IgA nephropathy with impaired renal function benefits from losartan treatment in rats. Ren Fail. 2013;35(6):812–8.CrossRefPubMed
17.
Banki NF, Ver A, Wagner LJ, Vannay A, Degrell P, Prokai A, et al. Aldosterone antagonists in monotherapy are protective against streptozotocin-induced diabetic nephropathy in rats. PLoS One. 2012;7(6):e39938.CrossRefPubMedPubMedCentral
18.
Bianchi S, Bigazzi R, Campese VM. Long-term effects of spironolactone on proteinuria and kidney function in patients with chronic kidney disease. Kidney Int. 2006;70(12):2116–23.CrossRefPubMed
19.
Aldigier JC, Kanjanbuch T, Ma LJ, Brown NJ, Fogo AB. Regression of existing glomerulosclerosis by inhibition of aldosterone. J Am Soc Nephrol. 2005;16(11):3306–14.CrossRefPubMed
20.
Hollenberg NK, Price DA, Fisher ND, Lansang MC, Perkins B, Gordon MS, et al. Glomerular hemodynamics and the renin-angiotensin system in patients with type 1 diabetes mellitus. Kidney Int. 2003;63(1):172–8.CrossRefPubMed
21.
Slomka T, Lennon ES, Akbar H, Gosmanova EO, Bhattacharya SK, Oliphant CS, et al. Effects of Renin-Angiotensin-Aldosterone System Blockade in Patients with End-Stage Renal Disease. Am J Med Sci. 2016;351(3):309–16.CrossRefPubMed
22.
•• Brener ZZ, Kotanko P, Thijssen S, Winchester JF, Bergman M. Clinical benefit of preserving residual renal function in dialysis patients: an update for clinicians. Am J Med Sci. 2010;339(5):453–6. The "aldosterone escape phenomenon” which is the base of combination of RAAS inhibitors and residual renal fucntion, protected with RAAS inhibitors, plays an important role in preservation of survival and quality of life of ESRD patients.CrossRefPubMed
23.
•• Bargman JM, Thorpe KE, Churchill DN, Group CPDS. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol. 2001;12(10):2158–62 (see comment above).PubMed
24.
•• Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol. 2002;13(5):1307–20 (see comment above).PubMed
25.
• Moist LM, Port FK, Orzol SM, Young EW, Ostbye T, Wolfe RA, et al. Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol. 2000;11(3):556–64. This demonstrated that ACEI/ARB has a beneficial effect on RRF of ESRD patients and possible mechanisms. PubMed
26.
• Reyes-Marín FA, Calzada C, Ballesteros A, Amato D. Comparative study of enalapril vs. losartan on residual renal function preservation in automated peritoneal dialysis. a randomized controlled study. Rev Invest Clin. 2012;64(4):315–21 (see comment above).PubMed
27.
Xydakis D, Papadogiannakis A, Sfakianaki M, Kostakis K, Stylianou K, Petrakis I, et al. Residual renal function in hemodialysis patients: the role of Angiotensin-converting enzyme inhibitor in its preservation. ISRN Nephrol. 2013;2013:184527.CrossRefPubMed
28.
• Taal MW, Brenner BM. Renoprotective benefits of RAS inhibition: from ACEI to angiotensin II antagonists. Kidney Int. 2000;57(5):1803–17 (see comment above).CrossRefPubMed
29.
• Noh H, Ha H, Yu MR, Kim YO, Kim JH, Lee HB. Angiotensin II mediates high glucose-induced TGF-beta1 and fibronectin upregulation in HPMC through reactive oxygen species. Perit Dial Int. 2005;25(1):38–47 (See comment above).PubMed
30.
• Imai H, Nakamoto H, Fukushima R, Ishida Y, Yamanouchi Y, Suzuki H. Role of adhesion molecules in the progression of peritoneal sclerosis. Adv Perit Dial. 2003;19:180–5 (See comment above).PubMed
31.
Rizkalla B, Forbes JM, Cooper ME, Cao Z. Increased renal vascular endothelial growth factor and angiopoietins by angiotensin II infusion is mediated by both AT1 and AT2 receptors. J Am Soc Nephrol. 2003;14(12):3061–71.CrossRefPubMed
32.
Menon MK, Naimark DM, Bargman JM, Vas SI, Oreopoulos DG. Long-term blood pressure control in a cohort of peritoneal dialysis patients and its association with residual renal function. Nephrol Dial Transplant. 2001;16(11):2207–13.CrossRefPubMed
33.
• Kyuden Y, Ito T, Masaki T, Yorioka N, Kohno N. Tgf-beta1 induced by high glucose is controlled by angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker on cultured human peritoneal mesothelial cells. Perit Dial Int. 2005;25(5):483–91 (See comment above).PubMed
34.
Luo W, Meng Y, Ji HL, Pan CQ, Huang S, Yu CH, et al. Spironolactone lowers portal hypertension by inhibiting liver fibrosis, ROCK-2 activity and activating NO/PKG pathway in the bile-duct-ligated rat. PLoS One. 2012;7(3):e34230.CrossRefPubMedPubMedCentral
35.
Mummidi S, Das NA, Carpenter AJ, Kandikattu H, Krenz M, Siebenlist U, et al. Metformin inhibits aldosterone-induced cardiac fibroblast activation, migration and proliferation in vitro, and reverses aldosterone+salt-induced cardiac fibrosis in vivo. J Mol Cell Cardiol. 2016;98:95–102.CrossRefPubMed
36.
Zhang L, Hao JB, Ren LS, Ding JL, Hao LR. The aldosterone receptor antagonist spironolactone prevents peritoneal inflammation and fibrosis. Lab Invest. 2014;94(8):839–50.CrossRefPubMed
Metadaten
Titel
Effects of RAAS Inhibitors in Patients with Kidney Disease
verfasst von
Fan Zhang
Hong Liu
Di Liu
Yexin Liu
Huiqiong Li
Xia Tan
Fuyou Liu
Youming Peng
Hongqing Zhang
Publikationsdatum
01.09.2017
Verlag
Springer US
Erschienen in
Current Hypertension Reports / Ausgabe 9/2017
Print ISSN: 1522-6417
Elektronische ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-017-0771-9

Weitere Artikel der Ausgabe 9/2017

Current Hypertension Reports 9/2017 Zur Ausgabe

Hypertension and the Kidney (RM Carey, Section Editor)

Hyperuricemia, Type 2 Diabetes Mellitus, and Hypertension: an Emerging Association

Therapeutic Trials (M Weir, Section Editor)

Primary Pediatric Hypertension: Current Understanding and Emerging Concepts

Blood Pressure Monitoring and Management (J Cockcroft, Section Editor)

Relevance of Haemodynamics in Treating Pre-eclampsia

Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)

Herbs Used for the Treatment of Hypertension and their Mechanism of Action

Hypertension and Obesity (E Reisin, Section Editor)

Regression of Left Ventricular Mass After Bariatric Surgery

Blood Pressure Monitoring and Management (J Cockcroft, Section Editor)

Pulse Waveform Analysis: Is It Ready for Prime Time?

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise