The presentation, “Advances in the Pathophysiology of CKD,” proved to be the most exciting part of our 2008 symposium, as it dealt with some of the most current and promising discoveries in the field. Genevieve Nguyen, M.D., Ph.D., Director of Research Institute National de la Sante’ et de la Recherche Medicale (INSERM), College de France in Paris, discussed her recent discovery of prorenin and its receptor and the implication of this receptor to kidney and cardiovascular disease. Prorenin is a precursor of renin, a well-known enzyme that converts angiotensinogen into angiotensin I and subsequently into angiotensin II, a hormone that can contribute to raising blood pressure and kidney damage in patients with CKD. For a long time it was established that the formation or action of angiotensin II could be blocked by ACE-inhibitors and sartans, drugs commonly used for the treatment of hypertension and to reduce progression of kidney disease and mortality in patients with heart failure. Dr. Nguyen provided evidence that these drugs may not completely block the renin-angiotensin-aldosterone system and binding of renin and prorenin to the renin receptor may mediate kidney injury even when patients are taking ACE-inhibitors and sartans. This discovery may lead to the development of antagonists of the renin receptors, enabling further kidney and cardiovascular protection.