[Nephroprotection by inhibition of the renin-angiotensin system--wish or reality?]

Angiotensin converting enzyme (ACE) inhibitors are used with increasing frequency in the treatment of hypertension in patients with chronic renal disease. In experimental models of chronic renal failure and, recently, in patients with diabetic nephropathy ACE inhibitors have also been shown to be effective on long-term administration in slowing the progression of renal failure. The exact mechanisms of this nephroprotective effect are not yet fully understood, but changes in hemodynamic parameters, a reduction of proteinuria and an inhibition of glomerular cell proliferation appear to be involved in preventing glomerulosclerosis.