International Journal of Molecular Medical Science, 2025, Vol.15, No.5, 235-243 http://medscipublisher.com/index.php/ijmms 238 protein (CRP), thereby alleviating chronic inflammation of the kidney. This immune-regulating effect is particularly important for elderly patients, as they usually have a more pronounced inflammatory response, which increases the risk of kidney injury. These drugs can reduce the degree of renal fibrosis by inhibiting the TGF-β signaling pathway and restoring the expression of anti-fibrotic small Rnas, especially when treated with ACEI (Chen, 2025). In addition, they can also reduce the accumulation of extracellular matrix, inhibit epithelial-mesenchymal transition (EMT), and help maintain the normal structure and function of the kidneys (Meng et al., 2020; Srivastava et al., 2020). This anti-fibrotic effect is of great significance for delaying the progression of chronic kidney disease (CKD) and improving the long-term renal function of elderly patients with hypertension. 4 Case Introduction and Treatment Plan 4.1 Patient profile In this case, there is an 80-year-old male patient who has long-term hypertension and was diagnosed with stage 3 chronic kidney disease (CKD), accompanied by persistent proteinuria. This patient also has type 2 diabetes and mild heart failure, which increases his risk of kidney and cardiovascular complications. Laboratory test results show that the estimated glomerular filtration rate (eGFR) is 45 mL/min/1.73m², accompanied by moderate proteinuria. Although this patient has adjusted his lifestyle, his blood pressure still hasn't been controlled to an ideal state (Georgianos and Agarwal, 2023). Such elderly patients usually encounter many problems, such as having to take multiple medications, being more sensitive to the side effects of drugs, and unstable kidney function. Therefore, during the treatment process, a cautious and individualized antihypertensive method should be adopted, especially when using renin-angiotensin-aldosterone system (RAAS) inhibitors. To select the right ACEI or ARB drugs, it is also necessary to determine the appropriate dosage. These two drugs are recommended as first-line treatment for patients with CKD complicated with proteinuria (Alcocer et al., 2023; Mhmndal et al., 2025). 4.2 Design of treatment plan During treatment, ACEI or ARB drugs are mainly used, and the dosage is gradually increased to the maximum level that the patient can tolerate. This can fully exert the protective effect of the drug on the kidneys and reduce proteinuria. There are the latest clinical guidelines and multiple studies supporting this treatment approach (Mhmndal et al., 2025). If patients have adverse reactions (such as cough or angioedema) when using ACEI, ARB drugs can be used instead, because the protective effect of these drugs on the kidneys is similar to that of ACEI, and patients are usually more adaptable. The goal of controlling blood pressure should be determined based on the specific condition of the patient. Generally, it is recommended to keep blood pressure below 130/80 mmHg. Meanwhile, pay more attention to possible side effects, such as hyperkalemia or changes in renal function (Figure 2) (Zhang et al., 2020; Georgianos and Agarwal, 2023). If blood pressure does not reach the ideal level, calcium channel blockers or thiazide diuretics should be used in combination, and the electrolyte and water balance in the body should be checked regularly (Mhmndal et al., 2025). If the patient's blood pressure is difficult to control, low-dose aldosterone receptor antagonists (such as spironolactone, spironolactone) can be considered for addition. However, in the advanced stage of chronic kidney disease, special attention should be paid to the risk of hyperkalemia, and close monitoring is very necessary. Control sodium intake, remind patients to take medicine on time, and ensure therapeutic effect (Alcocer et al., 2023). 4.3 Tracking and monitoring Regular follow-up is an important step in judging the treatment effect and safety, with a focus on blood pressure, renal function and whether there are any adverse reactions. The monitoring contents include serum creatinine, eGFR and serum potassium levels, especially at the beginning of ACEI/ARB or in the early stage of adjusting the dosage of such drugs. If hyperkalemia or acute kidney injury is detected, the dosage should be adjusted promptly or the drug temporarily discontinued (Zhang et al., 2020; Georgianos and Agarwal, 2023).
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