Renin-Angiotensin System Blockers and Renal Functional Reserve. Is There a Limit of Renoprotection?

Abstract

Renin-angiotensin system (RAS) blockers (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, direct renin inhibitor) have a renoprotective effect in the presence of preserved glomerular filtration rate in patients with chronic kidney disease. Exhausted renal functional reserve is associated with the loss of renoprotective properties of RAS blockers. There is a need to replace RAS blockers with moxonidine when estimated glomerular filtration rate is less than 30–15 ml/min.