Wiggins Kathryn J, Kelly Darren J
The University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Kidney Int. 2009 Jul;76(1):23-31. doi: 10.1038/ki.2009.105. Epub 2009 Apr 15.
Chronic kidney disease (CKD) is a common condition that is increasing in prevalence in developed nations. The economic and psychosocial costs of CKD are considerable, and are associated with high levels of morbidity and mortality. Specific treatments do not exist for many causes of CKD. Therefore, treatment is reliant on the introduction of therapies that retard progression of structural renal damage and renal impairment. At present, aside from judicious use of antihypertensive agents to lower blood pressure, and possibly low-protein diets and statin therapy, blockade of the renin-angiotensin-aldosterone system (RAAS) with angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) are the only widely available treatments. Although these measures attenuate the inexorable progression to renal failure, they do not halt it. One limiting factor may be feedback effects of ACEis and ARBs, such as increased plasma renin activity. Aliskiren is a newer agent that inhibits renin, the rate-limiting step in the RAAS. There are several theoretical reasons to suggest that aliskiren may have renoprotective actions superior to those of ACEis and ARBs. In this paper the available evidence regarding renoprotective effects of aliskiren is reviewed, with an emphasis on comparison with ACEis and ARBs.
慢性肾脏病（CKD）是一种常见疾病，在发达国家的患病率正不断上升。CKD的经济和社会心理成本相当高昂，且与高发病率和高死亡率相关。对于许多导致CKD的病因，尚无特效治疗方法。因此，治疗依赖于引入能够延缓肾脏结构损伤和肾功能损害进展的疗法。目前，除了合理使用抗高血压药物来降低血压，以及可能采用低蛋白饮食和他汀类药物治疗外，使用血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）阻断肾素-血管紧张素-醛固酮系统（RAAS）是唯一广泛应用的治疗方法。尽管这些措施可减缓向肾衰竭的不可避免进展，但并不能阻止其发生。一个限制因素可能是ACEI和ARB的反馈效应，如血浆肾素活性增加。阿利吉仑是一种新型药物，可抑制肾素，这是RAAS中的限速步骤。有几个理论依据表明，阿利吉仑可能具有优于ACEI和ARB的肾脏保护作用。本文对有关阿利吉仑肾脏保护作用的现有证据进行了综述，重点是与ACEI和ARB进行比较。
