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Editorial| Volume 355, ISSUE 5, P407-408, May 2018

Aldosterone Blockade Added to Renin-Angiotensin System Blockade to Reduce Albuminuria—A Path for Improved Renoprotection?

DOI:https://doi.org/10.1016/j.amjms.2018.01.012
Aldosterone Blockade Added to Renin-Angiotensin System Blockade to Reduce Albuminuria—A Path for Improved Renoprotection?
Next ArticleCardiovascular Disease and Alcohol Consumption
      In patients with diabetic nephropathy, lowering of albuminuria is an important short-term goal of treatment, as albuminuria is regarded as a surrogate for renoprotection.
      • Rossing P.
      • Hommel E.
      • Smidt U.M.
      • et al.
      Reduction in albuminuria predicts a beneficial effect on diminishing the progression of human diabetic nephropathy during antihypertensive treatment.
      Diabetologia. 1994; 37: 511-516
      The most effective intervention to reduce albuminuria is blockade of the renin-angiotensin system (RAS), using angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), as has been common practice since focused studies in 2001 showed a long-term renal and cardiovascular benefit of this treatment approach in patients with proteinuric type 2 diabetes.
      • Brenner B.M.
      • Cooper M.E.
      • de Zeeuw D.
      • et al.
      Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
      N Engl J Med. 2001; 345: 861-869
      , 
      • Lewis E.J.
      • Hunsicker L.G.
      • Clarke W.R.
      • et al.
      Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
      N Engl J Med. 2001; 345: 851-860
      However, what has also been evident ever since is the fact that many patients carry residual renal risk, and that further reduction of albuminuria and renal and cardiovascular risk would be potentially beneficial.
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      References

        • Rossing P.
        • Hommel E.
        • Smidt U.M.
        • et al.
        Reduction in albuminuria predicts a beneficial effect on diminishing the progression of human diabetic nephropathy during antihypertensive treatment.
        Diabetologia. 1994; 37: 511-516
        View in Article
        • Brenner B.M.
        • Cooper M.E.
        • de Zeeuw D.
        • et al.
        Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
        N Engl J Med. 2001; 345: 861-869
        View in Article
        • Lewis E.J.
        • Hunsicker L.G.
        • Clarke W.R.
        • et al.
        Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
        N Engl J Med. 2001; 345: 851-860
        View in Article
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        View in Article
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        View in Article

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      DOI: https://doi.org/10.1016/j.amjms.2018.01.012

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      © 2018 Southern Society for Clinical Investigation. Published by All rights reserved.

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