The RAAS system

• Poor kidneys can seem OK because the renin-angiotensin-aldosterone-system (RAAS) adjusts them to maintain their capacity (sub clinical kidney disease).

• This adjustment is achieved at the cost of rising blood pressure, reduced renal blood flow and increased occurrence of kidney damage.

• Blocking the RAAS, particularly with olmesartan, lowers blood pressure, increases renal blood flow and decreases the occurrence of kidney damage.

  These benefits of RAAS blockade are accompanied by a fall in kidney capacity. This can involve:
*         lowered GFR,
*         decreased sodium retention,
*         increased potassium retention,
*         decreased acid excretion,
*         decreased phosphate excretion and
*         lowered stimulus to RBC production.

  Out of range values observed with RAAS blockade can include:
*         high creatinine, 
*         high urea,
*         low sodium,
*         high potassium,
*         acidosis (low CO2 or bicarbonate),
*         low calcium,
*         high phosphate and
*         anemia.

  The out of range electrolytes (sodium, potassium, CO2 or bicarbonate, calcium and phosphate) could be of immediate concern. But they can be simply modulated by:
*         limitation of potassium rich foods
*         increased intake of salt (sodium chloride)
*         daily dosage with sodium bicarbonate
*         dosage with calcium carbonate (or calcium acetate) with high phosphate meals as required.