No effect of enalapril on progression in autosomal dominant polycystic kidney disease

Area of Science:

• Nephrology
• Pharmacology
• Genetics

Background:

• Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by cyst formation in the kidneys.
• Angiotensin-converting enzyme (ACE) inhibitors are known to reduce proteinuria and preserve renal function in other kidney diseases.
• The potential renoprotective effects of ACE inhibitors in ADPKD remain an area of investigation.

Purpose of the Study:

• To investigate the effect of enalapril, an ACE inhibitor, on renal function in patients with ADPKD.
• To evaluate whether enalapril can slow the decline of kidney function in both normotensive and hypertensive ADPKD individuals.

Main Methods:

• A 3-year randomized study involving 61 normotensive and 28 hypertensive ADPKD patients.
• Normotensive patients received either enalapril or placebo in a double-blind design.
• Hypertensive patients were randomized to open-label enalapril or atenolol, with renal function assessed by inulin clearance.

Main Results:

• In normotensive ADPKD patients, enalapril did not significantly alter the rate of renal function decline compared to placebo.
• In hypertensive ADPKD patients, both enalapril and atenolol showed similar effects on the decline of renal function.
• Enalapril effectively lowered blood pressure but did not impact microalbuminuria in either group.

Conclusions:

• This study did not find evidence that ACE inhibition with enalapril provides a protective benefit against renal function loss in ADPKD patients.
• The findings suggest that ACE inhibitors may not be effective in preserving kidney function in the context of ADPKD.
• Further research may be needed to explore alternative therapeutic strategies for managing renal function in ADPKD.