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RAS blockade in chronic kidney disease: Current evidence and future directions.
Antonio Vitiello1, Annarita Ponzo2, Mariarosaria Boccellino3
1Department of Health Prevention, Research and Emergencies, Italian Ministry of Health, Rome, 00144, Italy.
Naunyn-Schmiedeberg'S Archives of Pharmacology
|February 25, 2026
Summary
Renin-angiotensin system (RAS) blockade is a foundational therapy for chronic kidney disease (CKD) patients with proteinuria. It reduces kidney damage and works with newer agents like SGLT2 inhibitors for better outcomes.
Area of Science:
- Nephrology
- Pharmacology
- Cardiovascular Medicine
Background:
- Chronic kidney disease (CKD) is a significant global health concern with diverse causes like diabetes and hypertension.
- These conditions often lead to similar detrimental outcomes, including renal damage and proteinuria.
Purpose of the Study:
- To review the role of renin-angiotensin system (RAS) modifying agents in patients with renal diseases and significant proteinuria.
- To analyze the impact of RAS blockade on albuminuria, proteinuria, renal function, and disease progression.
Main Methods:
- Review of clinical evidence and biological rationale for RAS inhibition in CKD.
- Examination of the current therapeutic landscape, including combination therapies with agents like SGLT2 inhibitors.
Main Results:
- RAS blockade reduces albuminuria and proteinuria, stabilizes renal function, and slows CKD progression.
- Inhibition of RAS lowers intraglomerular pressure and mitigates renal damage.
- Optimal dosing, electrolyte monitoring, and comorbidity management are crucial for maximizing benefits.
Conclusions:
- RAS blockade is a cornerstone therapy for CKD with proteinuria, offering cardiovascular protection and reducing proteinuria.
- Future strategies involve optimized combination therapy, precise patient selection, and integrating novel pharmacological pathways for enhanced nephroprotection.
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