ACE Inhibition, Angiotensin II Receptor Blockade, and Diabetic Nephropathy
Only a large, rigorous randomized double-blind assessment of a therapeutic candidate compared to the appropriate alternative can prove therapeutic efficacy. One such trial assessed the effect of Captopril in patients with insulin-dependent diabetes mellitus (IDDM) who were at risk of nephropathy , with results that were sufficiently impressive that the use of Captopril quickly became a professional necessity supported by public policy. Moreover, multiple lines of evidence accumulated over a decade suggested that this useful feature of Captopril was a class action, extending to all ACE inhibitors. [2,3] In the case of the angiotensin II (Ang II) AT1 receptor blockers (AT1 antagonists), we are fortunate in having very early in the development of these agents two ongoing major, high quality trials in patients with NUDDM who are at risk of nephropathy — one involving Irbesartan, the other involving Losartan. Unfortunately, the outcome of these trials is unlikely to be available to us until the coming millennium, and this chapter is due well before!
KeywordsDiabetic Nephropathy Plasma Renin Activity Renin Inhibitor High Salt Diet Renin System
Unable to display preview. Download preview PDF.
- 5.Hollenberg NK. ACE inhibitors, AT1 receptor blockers, and the kidney. E. Ritz (Ed) Nephrol Dial Transplant 1997;12:381–383.Google Scholar
- 7.Roman RJ, Kaldunski ML, Scicli AG, and Carretero OA. Influence of kinins and angiotensin II on the regulation of papillary blood flow. Am J Physiol 1988;255:F690–F698.Google Scholar
- 8.Price D, DeOliveira J, Fisher N, and Hollenberg N. Contribution of Ang II to renal hemodynamics in healthy men: the renal vascular response to eprosartan, an Ang II antagonist. ASN Program Abstract # A1688 from 29th Annual Meeting in New Orleans, Nov. 3–6. J Am Soc Nephrol 1996,7:1587.Google Scholar
- 9.Price D, Porter L, DeOliveira J, Fisher N, Gordon M, Laffel L, Williams G, and Hollenberg N. The paradox of the low-renin state: hormonal and renal responses to an Ang II antagonist, Irbesartan, in diabetic nephropathy. ASN Program Abstract #A0591 from 29th Annual Meeting in New Orleans. J Am Soc Nephrology 1996;7:163.Google Scholar
- 11.Bjorck S. The renin-angiotensin system in diabetes mellitus: a physiological and therapeutic study. Scand JUrol Nephrol Suppl 1990;126:1–50.Google Scholar
- 13.Weidmann P, Ferrari P, and Shaw SG. Renin in Diabetes Mellitus. In: The Renin-Angiotensin System. In: JIS Robertson and MG Nicholls (Ed). Raven Press Ltd., New York, 1991. Chapter 75. pp. 75.1–75.26.Google Scholar
- 16.Anderson S, Jung FF, and Ingelfinger JR. Renal renin-angiotensin system in diabetes: functional immunohistochemical, and molecular biological correlations. Am J Physiol 1993;265:F477–F486.Google Scholar