[Angiotensin converting enzyme inhibitors in renal diseases]

Chronic diffuse renal diseases, involvement of the kidney in systemic and metabolic disorders are characterized by steady progression of renal pathology with loss of functional nephrons, lowering of renal functions and gradual development of chronic and eventually terminal renal failure. Basic mechanism of progression of chronic renal failure is activation of local renin-angiotensin system with intrarenal formation of a potent vasoconstrictor and growth factor - angiotensin II. Potentially nephroprotective effect can be achieved by pharmacological block of angiotensin II by angiotensin converting enzyme inhibitors. It has been shown in some prospective studies (AIPRI, REIN, ACEi-1 Trial, MICRO-HOPE) that the use of these drugs is associated with slowing of progression of renal pathology irrespective of its etiology and delayed development of terminal renal failure in patients with preexisting chronic renal insufficiency. Data available indicate that angiotensin converting enzyme inhibitors should be first line agents in the treatment of patients with chronic diffuse renal diseases of various etiology and diabetic nephropathy.