Angiotensin converting enzyme inhibitors and progressive renal insufficiency; current experience and future directions

Article Abstract:

Angiotensin converting enzyme (ACE) inhibitors prevent the formation of the natural factor angiotensin II, which constricts blood vessels. These ACE inhibitors are used to treat high blood pressure (hypertension). The rationale for using ACE inhibitors to treat kidney disease, and the effects of these agents in patients with hypertension and impaired kidney function were assessed. A review of the literature showed that ACE inhibitors decrease damage to the glomeruli, the units of small blood vessels that filter blood through the kidney, by reducing elevated pressures within the glomeruli and blood vessels throughout the body. ACE inhibitors have also been shown to reduce systemic blood pressure without affecting glomerular blood flow or filtration rate in hypertensive patients with kidney disease. These antihypertensive drugs improve proteinuria (the abnormal presence of blood proteins in the urine), but their effects on the progression of kidney disease unrelated to diabetes are not known. Because ACE inhibitors have not yet been approved by the Food and Drug Administration for treatment of kidney disease, their use is considered to be innovative. Review of the data shows that ACE inhibitors may reduce kidney function, particularly in patients with impaired function of both kidneys or heart disease, and may be associated with hyperkalemia (high blood potassium) in patients with diabetes or severely impaired kidney function. Thus, although ACE inhibitors reduce proteinuria in patients with kidney disease, their effects on the progression of kidney disease are still unknown. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Angiotensin converting enzyme inhibitors: the end of end-stage renal disease?

Article Abstract:

More than 30,000 persons with impaired kidney function develop end-stage or advanced kidney failure each year. These patients can survive with dialysis (the artificial filtration of the blood) or with kidney transplants, but this maintenance therapy is very costly. Drugs that delay or arrest the progression of kidney deterioration may be more cost-effective. Studies have shown that the angiotensin converting enzyme (ACE) inhibitors slow or halt impairment of kidney function associated with high blood pressure (hypertension) and diabetes. These agents act by inhibiting the formation of angiotensin, a natural factor that constricts blood vessels. Animal studies show that abnormal changes in kidney tissue are associated with increased blood flow and pressure in the glomeruli (the units of small blood vessels that filter blood in the kidney). Increased glomerular pressure results in tissue damage, which may progress to kidney failure. By decreasing blood pressure within the kidney, ACE inhibitors delay the deterioration of kidney tissue. Issues concerning the use of ACE inhibitors and other antihypertensive agents to prevent the progression of kidney damage include: the effectiveness of antihypertensive agents other than ACE inhibitors; the use of antihypertensive therapy for diabetes-associated kidney damage with or without hypertension; and the role of antihypertensive agents in treating glomerular diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus: a randomized, controlled trial

Article Abstract:

The ACE inhibitor enalapril appears to slow the development of kidney disease in patients with type 2, or adult-onset, diabetes. Researchers randomly assigned 156 patients with type 2 diabetes to take enalapril or a placebo every day. Six years later, those taking enalapril were less likely to develop a condition called microalbuminuria, which is an early sign of kidney malfunction. Other signs of kidney malfunction such as reduced creatinine clearance were also less likely in those taking enalapril.

Evaluation, Complications and side effects, Type 2 diabetes, Enalapril

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