Schmieder Roland E
Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
Curr Hypertens Rep. 2007 Nov;9(5):415-21. doi: 10.1007/s11906-007-0076-5.
Diabetic nephropathy and hypertension are the major causes of chronic kidney disease. The renin system plays a key role in the control of blood pressure (BP), as well as in the regulation of renal and adrenal function. Chronic activation of the renin system can lead to organ damage, particularly renal damage; increasing evidence indicates that suppression of the renin system can provide renal protection. Despite the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), the renin system is not completely suppressed. The direct renin inhibitors (DRIs) provide suppression of the entire renin system at the rate-limiting step. Studies in humans with early DRIs indicated potential renoprotective effects, but these agents failed in clinical development due to poor oral bioavailability. Aliskiren is a new orally active DRI with proven BP-lowering effects. Animal studies indicate that aliskiren may provide renal protection, and data from human studies are anticipated.
糖尿病肾病和高血压是慢性肾病的主要病因。肾素系统在血压（BP）控制以及肾脏和肾上腺功能调节中起关键作用。肾素系统的慢性激活可导致器官损伤，尤其是肾脏损伤；越来越多的证据表明，抑制肾素系统可提供肾脏保护。尽管使用了血管紧张素转换酶抑制剂（ACEIs）和血管紧张素II受体阻滞剂（ARBs），肾素系统仍未被完全抑制。直接肾素抑制剂（DRIs）在限速步骤可抑制整个肾素系统。早期直接肾素抑制剂在人体中的研究表明其具有潜在的肾脏保护作用，但由于口服生物利用度差，这些药物在临床开发中失败了。阿利吉仑是一种新型口服活性直接肾素抑制剂，已证实具有降压作用。动物研究表明，阿利吉仑可能提供肾脏保护，人类研究数据值得期待。
