Current evidence on the use of anti-RAAS agents in congenital or acquired solitary kidney

Abstract

Rational: The inhibition of renin-angiotensin-aldosterone system (RAAS) is a major strategy for slowing the progression of chronic kidney disease (CKD). The utility of anti-RAAS agents in patients with congenital or acquired solitary kidney is still controversial.

Objective: A systematic literature review was conducted.

Main findings: The conclusions of the few available studies on the topic are homogeneously in agreement with a long-term reno-protective activity of anti-RAAS drugs in patients with solitary kidney, especially if patients are hypertensive or proteinuric. However, angiotensin 2 (ANG2) levels permit a functional adaptation to a reduced renal mass in adults and is crucial for sustaining complete kidney development and maturation in children. A hormonal interference on ANG2 levels has been supposed in women. Consequently, at least in children and women, the use of ARBs appears more appropriate. Principle conclusions: Available data on this topic are limited; however, by their overall assessment, it would appear that anti-RAAS drugs might also be reno-protective in patients with solitary kidney. The use of ARBs, especially in children and in women, seems to be more appropriate. However, more experimental data would be strictly necessary to confirm this hypothesis.

Keywords: Congenital and acquired solitary kidney; RAAS inhibition; RAAS system; nephron hyperplasia; nephron hypertrophy.

Figure 1.

Glomerular distribution and conformation of a normal (a) and contralateral to nephrectomized fetal kidney (b) during active nephrogenesis stage.

Figure 2.

Alteration in both size and cortical thickness in a normal (c) and in a solitary single kidney (d) in renal sections.