Volume 2 Issue 10, October 2006

These authors present their controversial opinion that the evidence for a specific renoprotective effect of renin–angiotensin blockade, independent of blood-pressure control, is more ambiguous and the magnitude of any such effect much smaller than is often claimed. Data from several large trials of renin–angiotensin blockers and elegant renal cross-transplantation experiments in mice are proffered in support of their theory.

Authors from the University of Heidelberg present a provocative and comprehensive Review of the issues involved in management of hypertension in patients with type 2 diabetic nephropathy. After examining the relationships between the renin–angiotensin system (RAS), proteinuria and hypertension, Ritz and Dikow focus on controversies such as the effect of RAS blockade beyond blood-pressure reduction, and optimal doses of drugs that inhibit RAS.

When stimulated by pathogens or endogenous ligands, Toll-like receptors (TLRs) initiate production of myriad cytokines. Long known to reside on cells of the innate immune system, 10 of 11 TLRs have now been shown to be expressed in human kidney. Data supporting a role for these renal TLRs in a variety of conditions, including sepsis-induced acute renal failure, ischemic injury, and rejection of allografts, are presented.

Here, the concept of a self-perpetuating cyclical interaction between outcomes of oxidative stress (such as production of reactive oxygen species and depletion of antioxidants) and inflammatory mediators (such as cytokines), driving initiation and progression of hypertension, is presented. Experimental evidence to support operation of such a cycle is outlined, and the therapeutic implications of targeting the interactions therein are discussed.