Requirement of drug development for chronic renal disease: Other strategies than blockade of the renin-angiotensin system

The number of patients with chronic renal disease is increasing, hypertension and diabetes being major causes of it. Chronic renal disease progresses to the end-stage, of which a patient requires dialysis or transplantation, and thus prevention of progression of renal disease to the end-stage is a very important issue. Accumulating data indicate that angiotensin-converting enzyme (ACE) inhibitor is more effective than other antihypertensive drugs for treating chronic renal disease, since in addition to an antihypertensive effect, ACE inhibitor has a renoprotective effect. Although ACE inhibitor is more effective than other antihypertensive drugs, it only prevents the progression of chronic renal disease by less than 50%. Thus, in addition to blockers of the renin-angiotensin system, other types of drugs are required. Chronic renal disease progresses through a common pathway, regardless of the type of initial insult. This common pathway includes direct hemodynamic actions, modulation of glomerular cell injury, growth factor actions and induction of apoptosis. Blockade of this common pathway is one of the drug development strategies for chronic renal disease.