[Chronic kidney disease, new therapeutic approaches]

Despite the use of angiotensin blockers, chronic kidney diseases still progress. New therapeutic approaches aim to strengthen and to complete angiotensin blocker effects. Endothelin receptor antagonists, in addition to angiotensin blockers reduce blood pressure and urinary albumin excretion in diabetic nephropathies but can induce fluid overload. A second therapeutic approach consists in preventing the development of interstitial renal fibrosis which is a prognostic factor of CKD. Transforming growth factor-beta (TGF-beta) plays a major role in this process. Several molecules such as pirfenidone, microARN are in development to block TGF-beta or its downstream signaling pathways. Another approach aims to promote resolution of inflammation and renal repair Interesting experimental results were obtained with tyrosine kinase inhibitors and with methyl of bardoxolone in humans.