Background: Dual renin-angiotensin system blockade with angiotensin-converting enzyme inhibitors and
angiotensin receptor blockers has been advocated to minimize proteinuria. However, recent trials have questioned
the renal safety of this approach. Our understanding on the molecular effects of dual blockade in humans is
incomplete.
Case presentation: We present a patient with corticoid resistant nephrotic syndrome who developed marked
juxtaglomerular apparatus hyperplasia and renin expression in the context of dual angiotensin system blockade.
Conclusions: Although renin may have profibrotic effects mediated by (pro)renin receptor activation, this report
raises questions on the potential consequences of local renin activation on chronic kidney disease in patients with
dual angiotensin blockade.