renin-angiotensin system blockade reduces proteinuria and retards chronic kidney disease progression independent of blood pressure lowering
nephroprotection reflects both hemodynamic and nonhemodynamic mechanisms that culminate in attenuation of proinflammatory and profibrotic mediators in the renal parenchyma
angiotensin-converting enzyme (ACE) inhibitors were originally shown to retard progression of type 1 diabetic nephropathy (1)
ACE inhibitors are more effective than other antihypertensives in slowing progression of nondiabetic kidney disease (2)
a review found that the effectiveness of ACE inhibitors is similar across various baseline risks for disease progression in non-diabetic nephropathy (3)
however when stratified according to degree of proteinuria
among the subgroup of patients with proteinuria > or =500 mg/d, significant treatment effect was seen across all patients with a measurable outcome risk, including those at relatively low risk (1.7% annualized risk for progression).
there was no benefit of ACEI therapy among patients with proteinuria <500 mg/d, even among higher risk patients (control outcome rate 19.7%)
Reference:
(1) Brenner B. Retarding the progression of renal disease. Kidney Int 2003;64:370–378.
(2) Jaber BL et al. Progression of chronic kidney disease: Can it be prevented or arrested? The American Journal of Medicine 2005; 118 (12): 1323-1330.
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