What is the best method of nonspecific nephroprotection?

Jürgen Floege, MD, is a professor of medicine, director of the Division of Nephrology and Clinical Immunology at the University Hospital RWTH Aachen, Germany, and Distinguished Fellow of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA).

As of today, can we consider any of the available methods of nonspecific nephroprotection—that is, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), sodium-glucose cotransporter-2 (SGLT-2) inhibitors, or aldosterone receptor inhibitors—superior to others?

I think we have no good comparative studies and there probably will never be any.

It may be that this is a little dependent on the individual. Some patients may have [bigger] activation of the renin-angiotensin system (RAS) than others, but for practical purposes, I think we will go for combination therapy in the future more and more.

And as I said, we will probably start it right away and in parallel to protect as many nephrons as we can. So your question is probably an academic one.