Renin-Angiotensin System in Diabetic Nephropathy: From Bench to Bedside

This special issue reviews evolving and established concepts, and their translation into clinical application, of the renin-angiotensin system as it relates to the development of diabetic nephropathy, derived from in vitro and in vivo models. The topics covered range from basic science aspects to the clinical impact of various inhibitors of the renin-angiotensin system on nephropathy development. Emphasis is put on renal outcomes as well as on changes in surrogate endpoints such as proteinuria and blood pressure reduction. Basic aspects include the distribution and impact of various angiotensin receptor subtypes as well as numerous interactions of angiotensin II at the cellular level with different vasoactive peptides such as vascular epidermal growth factor, endothelin and amylin, an amyloid-like protein. A review of data from the diabetic rat, examining changes in the renin-angiotensin system in the context of salt loads and aging, completes this section. The clinical part presents a review of the epidemiology as well as clinical studies which examine the effect of inhibiting the renin-angiotensin system on progression of diabetic nephropathy. It features papers that focus on the role of ACE inhibition as well as selective angiotensin receptor blockade on renal outcomes in patients with either type 1 or type 2 diabetes. The impact of sodium intake on vascular reactivity and proteinuria in patients with diabetic nephropathy is also reviewed. Due to the wide range of topics covered, this publication will be of particular benefit to both basic researchers and those interested in clinical issues.