Tom 7, Nr 4 (2021)
Artykuł przeglądowy
Opublikowany online: 2021-12-30
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Kontrowersje wokół leczenia lekami blokującymi układ renina–angiotensyna–aldosteron (RAA) w nefrologii oraz chorobach układu sercowo-naczyniowego
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Nadciśnienie Tętnicze w Praktyce 2021;7(4):231-242.
Streszczenie
Leki hamujące układ renina–angiotensyna–aldosteron (RAA), takie jak inhibitory konwertazy angiotensyny (ACE-Is) oraz antagoniści receptora AT1 dla angiotensyny II (ARBs), są uznanym od lat, podstawowym kanonem nefroprotekcji. Powszechnie stosuje się je w monoterapii kłębuszkowych chorób nerek przebiegających z białkomoczem. Obecnie rzadziej zaleca się je w leczeniu skojarzonym w formie tak zwanej podwójnej blokady układu RAA w obawie o ewentualne działania niepożądane. Jednocześnie zarówno ACE-Is, jak i ARBs są także niesłusznie określane jako leki nefrotoksyczne. Upatruje się znaczenia terapii tymi lekami w wywoływaniu ostrego uszkodzenia nerek (AKI) czy też zaostrzenia przewlekłej choroby nerek (PChN).
Celem tej pracy jest próba zweryfikowania poglądów dotyczących związków pomiędzy prowadzeniem leczenia ACE-Is lub ARBs a rozwojem AKI oraz próba ponownego spojrzenia na rolę podwójnej blokady układu RAA w terapii chorób nerek. Omówiono również zasady terapii niewydolności serca (HF) z zastosowaniem ACE-Is lub ARBs oraz aktualne dane dotyczące znaczenia podwójnej blokady układu RAA w nadciśnieniu tętniczym.
Słowa kluczowe: ostre uszkodzenie nerekprzewlekła choroba nerekukład renina–angiotensyna–aldosteron (RAA)podwójna blokada układu RAAhamowanie progresji chorób nerek
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