Renin-Angiotensin System Modulation in Chronic Kidney Disease
Summary
The renin-angiotensin system (RAS) is a central regulator of blood pressure, fluid balance and structural integrity in the kidney. In chronic kidney disease (CKD), sustained activation of RAS drives glomerular hypertension, proteinuria and progressive nephron loss through hemodynamic stress and pro-fibrotic signalling. Pharmacological blockade—using angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)—remains the cornerstone of CKD management, slowing decline in glomerular filtration rate (GFR) and reducing cardiovascular risk. More recent work has expanded this paradigm by exploring non-steroidal mineralocorticoid receptor antagonists, dual endothelin-receptor inhibitors and aldosterone synthase inhibitors, each targeting complementary axes of RAS-mediated injury. Integration with sodium-glucose cotransporter-2 inhibitors and novel potassium-lowering agents has enabled more intensive RAS blockade while minimising hyperkalaemia, thereby enhancing nephroprotection. Across diverse patient populations—from diabetic nephropathy to advanced non-diabetic CKD—refined RAS modulation strategies continue to show real-world benefits in delaying end-stage renal disease and lowering cardiovascular morbidity.
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Renin-Angiotensin System Modulation in Chronic Kidney Disease publication trend
The graph below shows the total number of articles in renin-angiotensin system modulation in chronic kidney disease across all publications each year (not limited to Nature Index journals).
Technical terms
Renin-angiotensin system (RAS): Hormonal cascade regulating blood pressure, volume and kidney structure.
Angiotensin-converting enzyme inhibitor (ACE inhibitor): Drug blocking the conversion of angiotensin I to angiotensin II to lower blood pressure and proteinuria.
Angiotensin receptor blocker (ARB): Drug that prevents angiotensin II binding to its receptor, reducing vasoconstriction and fibrosis.
Mineralocorticoid receptor antagonist (MRA): Agent inhibiting aldosterone’s effects to mitigate sodium retention, fibrosis and inflammation.
Sodium-glucose cotransporter-2 inhibitor (SGLT2 inhibitor): Antihyperglycaemic drug that lowers glucose and intraglomerular pressure, offering renal protection.
Albuminuria: Elevated albumin in urine, a marker of glomerular damage and prognosis in CKD.
References
- Hypertension in chronic kidney disease—treatment standard 2023. Nephrology Dialysis Transplantation (2023).
- Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021. BMC Nephrology (2022).
- Therapeutic Insights in Chronic Kidney Disease Progression. Frontiers in Medicine (2021).
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