Aliskiren and the kidney: beyond hypertension

Aliskiren is a novel drug with the ability to lower plasma renin activity, reducing proteinuria in hypertension and in diabetic nephropathy. In primary and secondary glomerular diseases, important causes of end-stage kidney disease, proteinuria is a hallmark. Moreover, urinary protein is a marker of renal disease progression. The renin angiotensin aldosterone system is generally activated in these patients. A complete blockade with the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers with or without aldosterone receptor blockers is not easy to achieve, and side effects are not uncommon. Plasma renin activity is even increased in patients with this approach. Aliskiren should be considered as a new therapeutic option to be assessed in glomerular diseases, as plasma renin activity can be reduced and a better control of the renin-angiotensin system could be achieved with the consequent reduction in the amount of urinary protein excretion.