An update on proteinuric chronic kidney disease: The dual-goal approach

• Published in: Cleveland Clinic journal of medicine Vol. 75; no. 10; pp. 705 - 713
• Main Author: Hirsch, Sheldon
• Format: Journal Article
• Language: English
• Published: United States Cleveland Clinic 01.10.2008
• Subjects: Albuminuria - prevention & control; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; Disease Progression; Drug Therapy, Combination; Humans; Hyperkalemia - prevention & control; Hypertension - complications; Hypertension - physiopathology; Hypertension - prevention & control; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - prevention & control; Mineralocorticoid Receptor Antagonists - therapeutic use; Proteinuria - complications; Proteinuria - physiopathology; Proteinuria - prevention & control; Renin-Angiotensin System - drug effects
• ISSN: 0891-1150; 1939-2869
• DOI: 10.3949/ccjm.75.10.705

Lowering both blood pressure and urinary albumin excretion to specific goals may slow the progression of proteinuric chronic kidney disease. However, this dual-goal approach needs to be validated prospectively. KEY POINTS Evidence is emerging that urinary albumin is toxic to the kidney. Lowering both blood pressure and urinary albumin excretion, as a means to prevent progressive renal disease, appears to require aggressive inhibition of the renin-angiotensin-aldosterone system, often with several complementary drugs, ie, angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, aldosterone receptor antagonists, and possibly, direct renin inhibitors. Volume status and potassium levels may help suggest which of several available drugs could be added at different times. Serum potassium levels must be managed aggressively when using renin-angiotensin-aldosterone inhibitors in combination.