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Use of angiotensin-converting enzyme inhibitors in chronic progressive renal disease
B H Brouhard1, K C Irwin, R J Cunningham
1Department of Pediatrics, Cleveland Clinic Foundation, Ohio 44195.
Abstract:
Chronic renal insufficiency is a progressive, self-perpetuating process which is influenced in part by activation of the intrarenal renin-angiotensin system. Oral angiotensin-converting enzyme inhibitors are being studied in animals and humans to determine whether they slow the decline in renal function characteristic of progressive renal disease. In animals that have reduced renal mass, streptozotocin-induced diabetes mellitus, or puromycin aminonucleoside nephrosis, these agents can reduce proteinuria, decrease the frequency of sclerotic glomeruli, and normalize intrarenal hemodynamics. They also may decrease glomerular hypertrophy that occurs after renal ablation. In human trials, angiotensin-converting enzyme inhibitors decrease proteinuria by altering the glomerular capillary permeability. The effect of these agents on progressive disease may be influenced by how soon therapy is begun and how long it is continued.
Insights
Oral angiotensin-converting enzyme inhibitors show promise in slowing chronic renal insufficiency progression. Studies in animals and humans indicate these drugs reduce proteinuria and preserve kidney function, potentially by altering glomerular permeability.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Chronic renal insufficiency is a progressive condition.
- Activation of the intrarenal renin-angiotensin system contributes to disease progression.
Purpose of the Study:
- To evaluate the efficacy of oral angiotensin-converting enzyme inhibitors in slowing the decline of renal function.
- To assess the impact of these inhibitors on proteinuria and glomerular changes in animal models and human trials.
Main Methods:
- Animal studies included models of reduced renal mass, diabetes mellitus, and nephrosis.
- Human trials investigated the effects of angiotensin-converting enzyme inhibitors on proteinuria and renal function.
Main Results:
- In animals, these agents reduced proteinuria, decreased glomerular sclerosis, and normalized hemodynamics.
- Angiotensin-converting enzyme inhibitors were shown to decrease proteinuria in human trials by altering glomerular capillary permeability.
- Potential reduction in glomerular hypertrophy was observed in animal models.
Conclusions:
- Oral angiotensin-converting enzyme inhibitors demonstrate potential in managing chronic renal insufficiency.
- Therapeutic timing and duration are critical factors influencing the effectiveness of these agents in progressive renal disease.