References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

nid-978

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEWS AND LECTURES

Место блокаторов РАС в нефропротективной стратегии при хронической болезни почек (Обзор литературы)

Nephroprotective effects of antagonists of RAS in chronic kidney disease Review

Николаев

А. Ю.

Nikolaev

A. Yu.

nephrology@mail.ru

Ермоленко

В. М.

Ermolenko

V. M.

nephrology@mail.ru

Кафедра нефрологии и гемодиализа РМА ПО, г. МоскваRussian Federation

2010

17062025

121812

2025

Николаев А.Ю., Ермоленко В.М.

Nikolaev A.Y., Ermolenko V.M.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://journal.nephro.ru/jour/article/view/978

Представлен обзор литературы, посвященный клиническим аспектам применения блокаторов РАС при хронической болезни почек. Анализируется связь антигипертензивного и антипротеинурического эффектов – ведущих механизмов нефропротекции. Рассматриваются факторы риска осложнений терапии, а также проблема резистентности, связанная с феноменом «ускользания» альдостерона и ренина от блокаторoв РАС.

The review concerns nephroprotective (antihypertensive and antiproteinuric) effects of blockers of angiotensin II receptor and of ACE inhibitors in patients with chronic kidney disease. Complications of treatment with RAS antagonists including early and late onset acute renal failure and their association with aldosterone and renin escape are discussed.

хроническая болезнь почекнефропротекцияингибиторы ангиотензинпревращающего ферментаблокаторы АТI-рецепторов ангиотензина IIострая почечная недостаточностьрезистентность к блокаторам РАСchronic kidney diseasenephroprotectionACE inhibitorsblockers of АТI-receptors of angiotensin IIacute kidney failureresistance to RAS blockers

References1

Ермоленко В.М., Николаев А.Ю. Лекарственная острая почечная недостаточность / Руководство для врачей. Острая почечная недостаточность. M.: ГЭОТАР-Медиа. 2010. С. 130–137.

Мухин Н.А., Фомин В.В. Нефропротективная стратегия. Учебное пособие для послевузовского образования: Нефрология / Под ред. Е.М. Шилова. M.: ГЭОТАР-Медиа. 2007. С. 629–644.

Праскурничий Е.А. Ингибиторы ангиотензинпревращающего фермента. Руководство для врачей: Рациональная формакотерапия в нефрологии / Под ред. Н.А. Мухина, Л.В. Козловской, Е.М. Шилова. M.: Литтерра. 2006. С. 107–117.

Швецов М.Ю., Фомин В.В. Кутырина И.М. Ишемическая болезнь почек. Учебное пособие для поcлeвузовского образования: Нефрология / Под ред. Е.М. Шилова. M.: ГЭОТАР-Медиа. 2007. С 442–455.

Шестакова М.В., Дедов И.И. Cахарный диабет и хроническая болезнь почек. М.: Медицинское информационное агентство. 2009. 482 c.

Adamczak M., Gross M.L., Krtil J. Reversal of glomerulosclerosis after high dose enalapril in subtotally nephrectiomized rats // J. Am. Soc. Nephrol. 2003. Vol. 14. P. 2833–2842.

ADVANCE collaborate group. Effect of fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus // Lancet. 2007. Vol. 10. P. 140–167.

Agarwal R., Andersen M.J. Prognostic importance of clinic and home blood pressure recordings in patients with CKD // Kidney Int. 2006. Vol. 69. P. 406–411.

Aldigier J.S., Kanjanbuch T., Ma L.I. Regression of existing glomerulosclerosis by inhibition of aldosterone // J. Am. Soc. Nephrol. 2005. Vol. 16. P. 3306–3314.

Arora P., Pajagopalam S., Ranjan R. Preoperative use of ACEI/angiotensin receptor blockers is associated with increased risk for acute kidney injury after cardiovascular surgery // Clin. J. Am. Soc. Nephrol. 2008. Vol. 3. P. 1266–1273.

Atkins R.C., Briganti E.M., Lewis J.B. Proteinuria reduction and progression to renal failure in patients with type 2 diabetes and overt nephropathy – IDNT // AJKD. 2005. Vol. 45. P. 281–287.

Azizi M., Menard J., Bissery A. Pharmacologic demonstration of the synergistic effects of a combination of the renin inhibitor aliskiren and the AT1 receptor antagonist valsartan on the AII-renin feedback interruption // J. Am. Soc. Nephrol. 2004. Vol. 15. P. 3126–3133.

Bakris G.L., Weir M.R. ACEI-associated elevations of serum creatinine // Arch. Int. Med. 2000. Vol. 160. P. 685–693.

Barnet A.H., Bain S., Bouter P. Angiotensin-receptor blockade versus ACE inhibition in type 2 diabetes and nephropathy – DETAIL // N. Engl. J. Med. 2004. Vol. 351. P. 1952–1961.

Blankestijn P.I. Sympathetic activity in CKD // NDT. 2004. Vol. 19. P. 1354–1357.

Casas J.P., Chua W., Loukogeorgakis S. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on the renal outcomes: systematic review and meta-analysis // Lancet. 2005. Vol. 366. P. 2026–2033.

CDC (Centers for Disease Control and Prevention) for kidney disease – US, 1980–2005 // Morb. Mortal. Wkly Rep. 2008. Vol. 57. P. 309–312.

Chrysostomou A. Hyperkaliemia in chronic kidney disease // Clin. J. Am. Soc. Nephrol. 2006. Vol. 1. P. 256–262.

EUCLID study co-ordination center. Differences in albumin excretion rate response to lisinopil by ACE genotype in IDDM // Diabetologia. 1996. Vol. 39. Р. 60.

Forman J.P., Brenner B.M. Hypertension and microalbuminuria: the bell tolls for thee // Kidney Int. 2006. Vol. 69. P. 22–28.

From A.A., Bartholmai B.J., Williams A.W. Mortality associated with nephropathy after radiographic exposure // Mayo Clin. Proc. 2008. Vol. 83. P. 1095–1100.

Fujihara C.K., Velho M., Malheiros D.M. An extremly high dose of losartan affords superior renoprotection in the remnant model // Kidney Int. 2005. Vol. 67. P. 1913–1924.

Griffin K.A., Bidani A.K. Progression of renal disease: renoprotective specificity of RAS blockade. Clin. J. Am. Soc. Nephrol. // 2006. Vol. 1. P. 1054–1065.

Heart Outcomes Preventions Evaluation study. Effects of ramipril on cardiovascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy // Lancet. 2000. Vol. 355. P. 253–259.

Hollenberg N.K. Aldosterone in the development and progression of renal injury // Kidney Int. 2004. Vol. 66. P. 1–9.

Jafar T.H., Stark P.C., Schmid C.H., Landa M. AIPRD study group: progression of CKD: the role of BP control, proteinuria and ACE inhibition. A patient-level meta-analysis // Ann. Int. Med. 2003. Vol. 139. P. 244–252.

Jones C.A., Krolewski A.S., Rogus J., Xue J. Epidemic of ESRD in people with diabetes in the US population: do we know the cause? // Kidney Int. 2005. Vol. 67. P. 1684–1691.

Knight E.L., Glynn R.L., McIntyre K.M. Predictors of decreased renal function in patients with heart failure during ACE inhibitor therapy. Results of the Study of Left Ventricular Dysfunction – SOLVD // Am. Heart Dis. 1999. Vol. 138. P. 849–855.

Komenda P., Zalunardo N., Burnett S. Conservative outpatient renoprotection protocol in patients with low GFR undergoing contrast angiography: a case series // Clin. Exp. Nephrol. 2007. Vol. 11. P. 209–213.

Kovesdy C.P., Trivedi B.K., Kalantar-Zadeh K. Association of low BP with increased mortality in patients with moderate to severe CKD // NDT. 2006. Vol. 21. P. 1257–1262.

Laverman G.D., Anderson S., Rossing P. Renoprotection with and without blood pressure reduction // Kidney Int. 2005. Vol. 67 [Suppl 94]. Р. 54–59.

Locatelli F., Carbans I., Maschino G. Long-term progression of CKD in the AIPRI Extention study // Kidney Int. 1997. Vol. 52 [Suppl. 63]. Р. 63–66.

Mackinnon M., Shurraw S., Akbari A. Knoll G. Combination therapy with angiotensin receptor blocker and ACE inhibitor in proteinuric renal disease: a systematic review // AJKD. 2006. Vol. 48. P. 8–20.

Makino H., Hakeda M., Babazono T. Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: the INNOVATION study // J. Hypertens. Res. 2008. Vol. 31. P. 657–664.

Marre M., Fernandez M., Garsia-Puig J. Value of natrilix SR in hypertensive type 2 diabetic patients with microalbuminuria – NESTOR // J. Hypertens. Res. 2002. Vol. 20 (Suppl. 4). Р 338–342.

McMurrey J.J.V., Pitt B. Effects of oral direct renin inhibitor aliskiren in patients with symptomatic heart failure / Circulation-Heart Failure. 2008. Vol. 1. P. 17–24.

Minutolo R., Borelli S., Scigliano R. Prevalence and clinical correlates white coat hypertension in CKD // NDT. 2007. Vol. 22. P. 2217–2223.

Mogensen C.E., Viberti G.C., Halimi S. Randomized controlled trial of dual blockade of RAS in patients with hypertension, microalbuminuria and NIDDM: the candesartan and lisinopril microalbuminuria study – CALM // Btit. Med. J. 2000. Vol. 321. P. 1440–1444.

Nakao N., Yoshimura A.S., Morta H. Combination treatment of angiotensin II receptor blocker and ACE inhibitor in non-diabetic renal disease (COOPERATE) // Lancet. 2003. Vol. 361. P. 117–124.

Nguyen G. The (pro)renin receptors: pathophysiological roles in cardiovascular and renal pathology // Curr. Opin. Nephrol. Hypertens. 2007. Vol. 16. P. 129–133.

ONTARGET investigators. Yusuf S., Teo K.K., Pogue J. Telmisartan, ramipril or both in patients at high risk of vascular events // N. Engl. J. Med. 2008. Vol. 358. P. 1547–1559.

Onuigbo M.A., Onuigbo N.T. Late-onset renal failure from angiotensin blockade (LORFFAB) in 100 CKD patients // Int. Urol. Nephrol. 2008. Vol. 40. P. 233–239.

Onuigbo M.A. Analytical review of the evidence for renoprotection by renin-angiotensin-aldosterone system blockade in CKD – a call for caution // Nephron. 2009. Vol. 113. P. 63–70.

Orth S.R., Schroeder T., Ritz E. Effect of smoking on renal function in patients with type 1 and type 2 diabetes mellitus // NDT. 2005. Vol. 20. P. 2414–2419.

Parving H.H., Lehnert H., Brochner-Mortensen M.C. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes – IRMA-II // N. Engl. J. Med. 2002. Vol. 345. P. 870–878.

Parving H.H., Persson F. AVOID study. Aliskiren combined with losartan in type 2 diabetes and nephropathy // N. Engl. J. Med. 2008. Vol. 358. P. 2433–3446.

Peng H., Carretero O.A., Vuljaj N. ACE inhibitors: a new mechanism of action // Circulation. 2005. Vol. 112. P. 2436–2445.

Persson F., Rossing P., Schjoedt K.J. Time course of the antiproteinuric and antihypertensive effects of direct renin inhibitors in type 2 diаbetes // Kidney Int. 2008. Vol. 73. P. 1419–1425.

Pitt B., Remme W.J., Zannad F. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction // N. Engl. J. Med. 2003. Vol. 348. P. 1309–1321.

PROGRESS collaborative group. Randomized trial of perindopril-based BP-lowering regimen among 6105 patients with previous stroke // Lancet. Vol. 358. P. 1033–1041.

Rahman M., Pressel S., Davis B.R. Renal outcomes in high-risk hypertensive patients treated with ACEI or calcium channel blocker versus diuretics: a report of ALLHAT tial // Arch. Int. Med. 2005. Vol. 165. P. 936–946.

Rao M.V., Qiu Y., Wang C. Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004 // AJKD. 2008. Vol. 51. P. 30–37.

Ruggenenti P., Perna A., Benini R. In chronic nephropathies prolonged ACE inhibition can induce remission. Investigation of GISEN group // J. Am. Soc. Nephrol. 1999. Vol. 10. P. 997–1006.

Ruggenenti P., Fassi A., Ilieve A. Preventing microalbuminuria in type 2 diabetes – BENEDICT // N. Engl. J. Med. 2004. Vol. 351. P. 1941–1951.

Ruggenenti P., Perna A., Loriga G. REIN-2 study group. Blood pressure control for renoprotection in patients with non-diabetic CKD // Lancet. 2005. Vol. 365. P. 939–946.

Ruilope L.M., Segura J. Blood pressure lowering or selection of antihypertensive agents: which is more important? // NDT. 2006. Vol. 21. P. 843–845.

Rump L.Ch. Secondary rise of albuminuria under AT1-receptor blockade – what is the potential role of aldosterone escape? // NDT. 2007. Vol. 22. P. 5–8.

Russmann S., Lamerato L., Marfatia A. Risk of impaired renal function after colonoscopy: a cohort study in patients receiving either oral sodium phosphate or polyethylene glycol // Am. J. Gastroenterol. 2007. Vol. 102. P. 2655–2663.

Sarafidis P.A., Li S., Chen S.C. Hypertension awareness, treatment and control in CKD // Am. J. Med. 2008. Vol. 121. P. 332–340.

Sarnak M., Greene T., Wang X. The effect of lower target blood pressure on the progression of kidney disease: long-term follow-up of the MDRD study // Ann. Int. Med. 2005. Vol. 142. P. 342–351.

Schmieder R.E., Delles C., Mimran A. Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes – TRENDY // Diabetes Care 2007. Vol. 30. P. 1351–1356.

Schrier R.W., Estacio R.O., Esler A. Effects of aggressive BP control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes // Kidney Int. 2002. Vol. 61. P. 1086–1097.

Seegall L., Covic A., Goldsmith D.J.A. Direct renin inhibitors: the dawn of a new era, or just a variation on a theme? // NDT. 2007. Vol. 22. P. 2435–2439.

Suissa S., Hutchinson T., Brophy J.M., Kezouh A. ACE-inhibitor use and the long-term risk of renal failure in diabetes // Kidney Int. 2006. Vol. 69. P. 913–919.

Viberti G., Wheeldon N.M. Microalbuminuria reduction with valsartan in patients with type 2 diabetes: a BP independent effect – MARVAL // Circulation. 2002. Vol. 106. P. 672–678.

Wachtell K., Ibsen H., Olsen M.H. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study // Ann. Int. Med. 2003. Vol. 139. P. 901–906.

Wolf G., Ritz E. Combination therapy with ACE inhibitors and AII receptor blockers to halt progression of chronic kidney disease: pathophysiology and indications // Kidney Int. 2005. Vol. 67. P. 799–812.

Wright Ir., Bakris G., Greene T. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results of the AASK trial // JAMA. 2002. Vol. 288. P. 2421–2431.

De Zeeuw D., Remuzzi G., Parving H.H. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL // Kidney Int. 2004. Vol. 65. P. 2309–2320.

Zhu S., Liu Y., Wang L. TGF-beta-1 is associated with kidney damage in patients with essential hypertension: renoprotective effect of ACE inhibitor and/or AII receptor blocker // NDT. 2008. Vol. 23. P. 2941–2846.

The authors declare that there are no conflicts of interest present.