Unmet need in renal protection--do we need a more comprehensive approach?

Progressive renal function loss is still a threat to health despite the presence and use of renal protective drugs such as ACEi and ARB. This unmet need appears to be related to factors like a residual high blood pressure and residual albuminuria. Strategies that enhance the efficacy of RAAS blockade, such as increasing the dose of ACEi or ARB, combining ACEi and ARB, or new RAAS inhibitor drugs like the direct renin inhibitors may help us in improving renal protection. However, it is likely that renal disease progression is caused by multiple risk factors and that we will need multiple approaches to tackle this residual risk. Recent trials testing the effect of vitamin D receptor activators and the effect of statins indicate that drugs in these classes may become valuable extra tools (in addition to ACEi or ARB) to tackle the unmet need in renal protection.