Renin Angiotensin System Blockade and Nephropathy: Why Is It Being Called into Question, and Should It Be?

[摘要] As is widely known, the first drug that was approved by the Food and Drug Administration for retarding the progression of renal injury was captopril, an angiotensin-converting enzyme (ACE) inhibitor that worked primarily through blocking the renin system (1). The study was performed in patients with type 1 diabetes. Several years later, the Food and Drug Administration approved renin-angiotensin system blockade with two angiotensin antagonists, irbesartan and losartan, for the management of nephropathy in patients with type 2 diabetes (2–4). The regulatory agency demands solid evidence, and they had it. Each of these studies, designed and conducted by experts, was large enough, used enough drug, and treated for long enough to lead to an outcome, which essentially was beyond debate. The conclusions from the major studies were supported by meta-analyses that examined additional issues, such as whether the drugs were effective in the patient who has renal injury that is not due to diabetes (5,6).

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome