In patients at low risk of renal disease and with low levels of albuminuria, administration of renin–angiotensin system inhibitors does not seem to offer renal benefits and might cause adverse renal effects. In these patients, renin–angiotensin system inhibition should be implemented judiciously, with doses titrated to individual needs and with careful monitoring of kidney function.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Mann, J. F. et al. Effect of telmisartan on renal outcomes: a randomized trial. Ann. Intern. Med. 151, 1–10 (2009).
Lewis, E. J., Hunsicker, L. G., Bain, R. P. & Rohde, R. D. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N. Engl. J. Med. 329, 1456–1462 (1993).
Brenner, B. M. et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N. Engl. J. Med. 345, 861–869 (2001).
[No authors listed] Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Lancet 349, 1857–1863 (1997).
Agodoa. L. Y. et al. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 285, 2719–2728 (2001).
Jafar, T. H. et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann. Intern. Med. 135, 73–87 (2001).
Ibsen, H. et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension 45, 198–202 (2005).
de Zeeuw, D. et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int. 65, 2309–2320 (2004).
de Zeeuw, D. et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 110, 921–927 (2004).
Ito, S., Nagasawa, T., Abe, M. & Mori, T. Strain vessel hypothesis: a viewpoint for linkage of albuminuria and cerebro-cardiovascular risk. Hypertens. Res. 32, 115–121 (2009).
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author declares no competing financial interests.
Rights and permissions
About this article
Cite this article
Ito, S. Usefulness of RAS inhibition depends on baseline albuminuria. Nat Rev Nephrol 6, 10–11 (2010). https://doi.org/10.1038/nrneph.2009.203
Issue Date:
DOI: https://doi.org/10.1038/nrneph.2009.203
This article is cited by
-
The angiotensin II type 1 receptor blocker olmesartan preferentially improves nocturnal hypertension and proteinuria in chronic kidney disease
Hypertension Research (2013)
-
Cardiorenal connection in chronic kidney disease
Clinical and Experimental Nephrology (2012)