Lozano-Maneiro Luz, Puente-García Adriana
Division of Nephrology, Department of Internal Medicine, Fuenlabrada University Hospital, Rey Juan Carlos University School of Medicine, Camino del Molino, 2, 28942 Fuenlabrada, Madrid, Spain.
J Clin Med. 2015 Nov 9;4(11):1908-37. doi: 10.3390/jcm4111908.
Diabetic Kidney Disease (DKD) is the leading cause of chronic kidney disease in developed countries and its prevalence has increased dramatically in the past few decades. These patients are at an increased risk for premature death, cardiovascular disease, and other severe illnesses that result in frequent hospitalizations and increased health-care utilization. Although much progress has been made in slowing the progression of diabetic nephropathy, renal dysfunction and the development of end-stage renal disease remain major concerns in diabetes. Dysregulation of the renin-angiotensin-aldosterone system (RAAS) results in progressive renal damage. RAAS blockade is the cornerstone of treatment of DKD, with proven efficacy in many arenas. The theoretically-attractive option of combining these medications that target different points in the pathway, potentially offering a more complete RAAS blockade, has also been tested in clinical trials, but long-term outcomes were disappointing. This review examines the "state of play" for RAAS blockade in DKD, dual blockade of various combinations, and a perspective on its benefits and potential risks.
糖尿病肾病（DKD）是发达国家慢性肾病的主要病因，在过去几十年中其患病率急剧上升。这些患者过早死亡、患心血管疾病和其他严重疾病的风险增加，这些疾病导致频繁住院和医疗保健利用率上升。尽管在减缓糖尿病肾病进展方面已取得很大进展，但肾功能不全和终末期肾病的发展仍然是糖尿病的主要关注点。肾素-血管紧张素-醛固酮系统（RAAS）失调会导致进行性肾损伤。RAAS阻断是DKD治疗的基石，在许多方面已证实有效。将这些针对该途径不同点的药物联合使用这一理论上有吸引力的选择，可能提供更完全的RAAS阻断，也已在临床试验中进行了测试，但长期结果令人失望。本综述探讨了DKD中RAAS阻断的“现状”、各种联合的双重阻断及其益处和潜在风险的观点。
