Angiotensin-converting enzyme inhibition and renal protection: An assessment of implications for therapy

Norman K. Hollenberg, Leopoldo Raij

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

The role of hypertension in the pathogenesis of renal damage is a subject of both historical interest and current investigation. Because of the difficulty associated with studying the pathophysiologic role of glomerular injury in systemic hypertension, experimental models have provided much of the data in this field. The mechanisms leading to glomerular injury are complex and not fully elucidated. Mesangial and endothelial cell injury are thought to be important pathophysiologic mechanisms in the renal injury associated with hypertension. One hypothesis suggests that glomerular hypertension (ie, a hemodynamic event) is the primary pathogenetic mechanism, but another supports the notion that glomerular hypertrophy (ie, abnormal growth-related events) contributes to injury. The intrarenal renin-angiotensin system may play an important pathogenetic role in end-stage renal disease. Angiotensin-converting enzyme (ACE) inhibition has been shown to arrest the progression of renal injury in animal models. Although the clinical database is incomplete, the findings of anecdotal reports and short-term studies suggest that ACE inhibition may preserve renal function in patients with scleroderma renal crisis, reduce proteinuria in patients with diabetic nephropathy, and normalize renal hemodynamics in patients with a variety of renal diseases. The beneficial effects of ACE inhibition may be due to both hemodynamic (eg, reduction in glomerular capillary and intraglomerular pressures) and nonheniodynamic (eg, potassium-sparing and reduction in mesangial proliferation) mechanisms. The precise role of ACE inhibitors in the prevention of renal damage awaits the results of ongoing long-term, double-blind clinical studies. Nevertheless, ACE inhibition may be an appropriate therapeutic alternative in the hypertensive patient whose renal injury is progressing despite aggressive antihypertensive therapy.

Original languageEnglish
Pages (from-to)2426-2435
Number of pages10
JournalArchives of Internal Medicine
Volume153
Issue number21
StatePublished - Nov 8 1993
Externally publishedYes

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Peptidyl-Dipeptidase A
Kidney
Wounds and Injuries
Hypertension
Therapeutics
Hemodynamics
Mesangial Cells
Diabetic Nephropathies
Renin-Angiotensin System
Proteinuria
Double-Blind Method
Angiotensin-Converting Enzyme Inhibitors
Hypertrophy
Antihypertensive Agents
Chronic Kidney Failure
Potassium
Theoretical Models
Endothelial Cells
Animal Models
Databases

ASJC Scopus subject areas

  • Internal Medicine

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Angiotensin-converting enzyme inhibition and renal protection : An assessment of implications for therapy. / Hollenberg, Norman K.; Raij, Leopoldo.

In: Archives of Internal Medicine, Vol. 153, No. 21, 08.11.1993, p. 2426-2435.

Research output: Contribution to journalArticle

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