Related Experiment Video

Updated: Feb 5, 2026

Nitropeptide Profiling and Identification Illustrated by Angiotensin II
07:31

Nitropeptide Profiling and Identification Illustrated by Angiotensin II

Published on: June 16, 2019

6.1K

Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report

Matthew R Weir1, Jay I Lakkis2, Bernard Jaar3

  • 1Division of Nephrology, Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 12, 2018
PubMed

Insights

Renin-angiotensin system (RAS) blockade effectively slows chronic kidney disease (CKD) progression. However, its use in advanced CKD requires further research to balance benefits and risks, especially concerning estimated glomerular filtration rate (eGFR) changes.

Area of Science:

  • Nephrology
  • Pharmacology

Background:

  • Renin-angiotensin system (RAS) blockade, using ACE inhibitors or ARBs, is proven to slow chronic kidney disease (CKD) progression.
  • Most trials exclude patients with advanced CKD (eGFR <30 mL/min/1.73m²).
  • RAS blockade initiation can cause acute, potentially functional, eGFR reduction.

Purpose of the Study:

  • To discuss controversies surrounding RAS blockade use in advanced CKD.
  • To review existing data on RAS blockade's impact on eGFR and potassium in advanced CKD.
  • To provide perspective on the therapeutic index of RAS blockade in this population.

Main Methods:

  • Literature review of published data.
  • Analysis of the impact of RAS blockade on estimated glomerular filtration rate (eGFR).
  • Assessment of effects on serum potassium levels.

Main Results:

  • RAS blockade may preserve kidney function long-term by reducing glomerular pressure.
  • Acute eGFR reduction is a known, potentially reversible, effect.
  • Data on advanced CKD patients is limited, highlighting a need for more research.

Conclusions:

  • More research is essential to determine the safety and efficacy of RAS blockade in advanced CKD.
  • The therapeutic index of RAS blockade in advanced CKD remains to be fully elucidated.
  • Understanding the balance between eGFR changes and long-term kidney protection is crucial.
Keywords:
RAAS blockadeRenin angiotensin aldosterone system (RAAS)advanced CKDangiotensin II receptor blockers (ARBs)angiotensin converting enzyme inhibitors (ACEi)blood pressurecardiovascular riskchronic kidney disease (CKD)diabetesdrug safetyend-stage renal disease (ESRD)estimated glomerular filtration rate (eGFR)hypertensionmortalityproteinuriareduced eGFRrenal disease progression

More Related Videos

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy08:50

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Published on: June 25, 2013

13.7K
A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis08:21

A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis

Published on: October 26, 2020

5.6K

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
1.1K
Neuromuscular Junction And Blockade01:29

Neuromuscular Junction And Blockade

The site of chemical communication between a motor neuron and a muscle fiber is called the neuromuscular junction (NMJ). The end of the motor neuron at the NMJ divides into a cluster of synaptic end bulbs. The cytoplasm of these bulbs consists of synaptic vesicles enclosing acetylcholine molecules, the principal neurotransmitter released at the NMJ. The region opposite the synaptic bulb that ends in the muscle fiber is called the motor end plate, which has acetylcholine receptors. Within the...
5.1K
Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
1.5K
Hormonal Regulation01:33

Hormonal Regulation

The renin-aldosterone system is an endocrine system which guides the renal absorption of water and electrolytes, thus managing blood pressure and osmoregulation. Activation of the system begins in the kidneys with a small cluster of cells adjacent to the afferent and efferent blood vessels of the renal corpuscle. As the nephrons are filtering blood, juxtaglomerular cells monitor blood pressure. If they detect a decrease in pressure, they release the hormone renin into the bloodstream.
36.1K
Data Reporting and Recording01:24

Data Reporting and Recording

Reporting and recording are crucial in data documentation. The timely, thorough, and accurate documentation of facts is essential when recording patient data. Failure to record findings during an assessment or interpretation of a problem will result in loss of information and make the patient document unreliable. The reader is left with general impressions if the information is not specific. A recording is documenting data of the individual's health information in a traceable, secure, and...
5.5K
Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
2.7K