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Nephrol Dial Transplant (2003) 18: V21-V23
© 2003 European Renal Association-European Dialysis and Transplant Association

Treatment of diabetic nephropathy with angiotensin II blockers

Sándor Sonkodi and A. Mogyorósi

First Department of Medicine, Faculty of Medicine, Szeged University, Szeged, Hungary

The increased activity of the renin–angiotensin–aldosterone system (RAAS) is an important pathogenetic factor in the development of nephropathy in diabetic patients. The damaging factor of this system is the end-product, angiotensin II, and the damaging effects are vasoconstriction, increase of aldosterone secretion, growth, fibrosis, thrombosis, inflammation and oxidation. Theoretically, on this basis, blockade of the RAAS should have a beneficial effect on the development of diabetic nephropathy. The main goal in the treatment of diabetic nephropathy is control of the glycaemic status and aggressive antihypertensive therapy, primarily with RAAS-blocking agents. It was demonstrated recently that angiotensin II receptor blockers (ARBs) have a slowing effect on the progression of diabetic nephropathy (RENAAL and IDNT trials) or on the development of proteinuria (IRMA) in type 2 diabetes. These effects are specific and independent of the decrease in blood pressure. Theoretically, the combination of an angiotensin-converting enzyme inhibitor (ACEI) and an ARB can lead to a more complete blockade of the RAAS. A new study (ONTARGET) has now started to investigate whether treatment with a combination of an ACEI and an ARB has a more potent beneficial effect on the cardiovascular events and the nephropathy in type 2 diabetic patients as compared with separate treatment with the two agents.

Keywords: AT1 receptor blocker; diabetic nephropathy; renin-angiotensin-aldosterone system

Correspondence and offprint requests to: Sándor Sonkodi MD, PhD, DSc, First Department of Medicine, Faculty of Medicine, Szeged University, 6720 Szeged, Korányi fasor 10, Hungary. E-mail: sons{at}in1st.szote.u-szeged.hu


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