Renal involvement in patients with type 2 diabetes carries a risk of increased cardiovascular mortality. This is particularly true in the presence of microalbuminuria being an early marker of endothelial dysfunction. The use of Renin Angiotensin Aldosterone System (RAAS) blockers has been found beneficial in improving endothelial dysfunction as well as preventing development of microalbuminuria and its progression to macroalbuminuria. This class of drugs has been proved effective in delaying the development of end stage renal disease. However; in patients with established end stage renal disease, it becomes controversial whether using these drugs may still be beneficial. Indeed, some studies have shown that they may even be harmful if used in late stages of chronic kidney disease. In this article, we will review firstly, the renovascular changes in health and disease and secondly appraise the different trial data pertaining to the assessment of the use of various RAAS inhibitors at different stages of the renal continuum. We hope the review will help put together a physiologicallybased fundamental knowledge and a trial-derived evidence base for to help inform day to day decision-making in clinical practice.
Key-words:
RAAS - Diabetes - Microalbuminuria - Hypertension - Endothelial dysfunction
