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**25**

*Japan* 

Hiroyuki Sasamura

**Prevention and Regression of Chronic**

*Department of Internal Medicine, School of Medicine, Keio University* 

Chronic kidney disease (CKD) is a disease which is characterized by the presence of renal damage or decreased GFR for at least 3 months. The prevalence of CKD in the US has been reported to be 3.3% (stage 1), 3.0% (stage 2), 4.3% (stage 3), 0.2% (stage 4), and 0.1% (stage 5) (Levey et al., 2003; 2002). Because of the increasing elderly population in industrial countries, the development of new strategies for the prevention and regression of CKD is

Clinical studies have suggested that renin-angiotensin system (RAS) inhibitors can exert a renoprotective effect independent of blood pressure, and attenuate the progression of renal dysfunction (Bakris, 2010; Berl, 2009; Stojiljkovic et al., 2007). Recent studies have suggested that the use of RAS inhibitors, when combined with other treatment modalities such as aggressive blood pressure control, lowering of blood lipids, tight glucose control for diabetics, and lifestyle changes may cause remission of albuminuria, and stablization or even reversal of the decline in GFR, i.e. regression of CKD in some patients (Aros et al., 2002;

These early clinical findings are important, because they suggest that appropriate interventions may be effective for causing an improvement in renal function, which raises the hope that a 'cure' for CKD may eventually be found in the future. In our laboratory, we have been examining the molecular mechanisms involved in the pathogenesis of CKD and hypertension. Our underlying concept is that both these diseases are highly related, and share common pathophysiological mechanisms, including the abnormal accumulation of extracellular matrix proteins in the kidney. The result is glomerulosclerosis, when the matrix accumulates in the renal glomeruli, and renal arteriolosclerosis, when the matrix is deposited in the renal arterioles and small vessels. In this chapter, we will review the evidence from our and other laboratories that these processes may be reversed in animal

Regardless of the initial injury, most causes of CKD (including diabetic nephropathy, and chronic glomerulonephritis) share several common pathological features, one of which is the

**1. Introduction**

important.

Macconi, ; Ruggenenti et al., 2008).

models, and possibly in humans.

**2.1 Studies on CKD prevention** 

development of glomerular scarring or glomerulosclerosis.

**Kidney Disease and Hypertension** 

