Angiotensin-Converting Enzyme Inhibitors and Progression of Diabetic Nephropathy
Authors: George L. Bakris
Journal: Annals of Internal Medicine (1993)

Editorials15 April 1993Angiotensin-Converting Enzyme Inhibitors and Progression of Diabetic NephropathyGeorge L. Bakris, MDGeorge L. Bakris, MDRush Presbyterian St. Luke's Medical Center, Chicago, IL 60612.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-8-199304150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A number of studies have examined the effects of angiotensin-converting enzyme (ACE) inhibitors on progression of diabetic renal disease and microalbuminuria in both normotensive and hypertensive patients with Type I diabetes. Four moderately sized, prospective trials in normotensive patients with Type I diabetes, however, clearly show that ACE inhibitors reduce microalbuminuria and preserve renal function without reducing arterial pressure. These studies also show that reductions in microalbuminuria correlate with preservation of renal function. The current study by Ravid and colleagues, in this issue of Annals, is the first to show that ACE inhibitors reduce microalbuminuria and slow progression of renal ...References1. Knowler WC, Kunzelman CL. Population comparisons of the frequency of diabetic nephropathy. In: Mogensen CE, ed. The Kidney and Hypertension in Diabetes Mellitus. Boston: Martinus Nijhoff. 1988:25-32. Google Scholar2. Bakris GL. Calcium abnormalities and the diabetic, hypertensive patient: Implications of renal preservation. In: Epstein M, ed. Calcium Antagonists in Clinical Medicine. Philadelphia: Harley & Belfus; 1992, 367-89. Google Scholar3. Slataper R, Vicknair N, Sadler R, Bakris GL. Comparative effects of different antihypertensive treatments on progression of diabetic renal disease. Arch Intern Med. (In press.) Google Scholar4. Parving HH, Andersen AR, Smidt UM, Hommel E, Mathiesen ER, Svendsen PA. Effect of antihypertensive treatment on kidney function in diabetic nephropathy. 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The fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med. 1993; 153:154-83. Google Scholar Author, Article, and Disclosure InformationAffiliations: Rush Presbyterian St. Luke's Medical Center, Chicago, IL 60612.Corresponding Author: George L. Bakris, MD, Departments of Preventive and Internal Medicine, Rush Presbyterian St. Luke's Medical Center, Suite 117, 1725 West Harrison Parkway, Chicago, IL 60612. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLong-Term Stabilizing Effect of Angiotensin-Converting Enzyme Inhibition on Plasma Creatinine and on Proteinuria in Normotensive Type II Diabetic Patients Mordchai Ravid , Hilel Savin , Itzhak Jutrin , Tamir Bental , Bernard Katz , and Michael Lishner Metrics Cited ByGlomerular hyperfiltration: definitions, mechanisms and clinical implicationsPersistent renin-angiotensin system activation after anti-reflux surgery and its managementHyperglycemia alters renal cell responsiveness to pressure in a model of malignant hypertensionHeterogeneous Nuclear Ribonucleoprotein K Modulates Angiotensinogen Gene Expression in Kidney CellsRole of EGF Receptor Activation in Angiotensin II–Induced Renal Epithelial Cell HypertrophyACE-inhibitor use and the long-term risk of renal failure in diabetesGlucose Mediates Transcriptional Repression of the Human Angiotensin Type-1 Receptor Gene: Role for a Novel Cis -acting ElementHigh Glucose Stimulates Angiotensinogen Gene Expression and Cell Hypertrophy via Activation of the Hexosamine Biosynthesis Pathway in Rat Kidney Proximal Tubular CellsUsefulness of captopril renography to predict the benefits of renal artery revascularization or captopril treatment in hypertensive patients with diabetic nephropathyHigh Glucose Stimulates Angiotensinogen Gene Expression via Reactive Oxygen Species Generation in Rat Kidney Proximal Tubular CellsEssential Role(s) of the Intrarenal Renin-Angiotensin System in Transforming Growth Factor–β1 Gene Expression and Induction of Hypertrophy of Rat Kidney Proximal Tubular Cells in High GlucoseHigh Levels of Glucose Stimulate Angiotensinogen Gene Expression Via the P38 Mitogen-Activated Protein Kinase Pathway in Rat Kidney Proximal Tubular Cells**This work was supported by grants from the Medical Research Council of Canada (MT-13420 to J.S.D.C. and J.G.F., and MT-12573 to J.G.F.) and from the NIH (HL-48455 to J.R.I., and D.K-50836 to S.S.T.).Effect of Antihypertensive Therapy on Renal Injury in Type 2 Diabetic Rats With HypertensionMolecular mechanism(s) of insulin action on the expression of the angiotensinogen gene in kidney proximal tubular cellsAngiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs) and Lactation: An UpdateEffect of AT1 angiotensin receptor antagonist on lipid peroxidation and antioxidative defense in diabetic kidneyEffect of angiotensin convertase inhibitors and AT1 angiotensin receptor antagonists on the development of oxidative stress in the kidney of diabetic ratsMolecular mechanisms of glucose action on angiotensinogen gene expression in rat proximal tubular cellsAn overview of the influence of ACE inhibitors on fetal-placental circulation and perinatal developmentAngiotensin-Converting Enzyme Inhibitor FetopathyThe role of angiotensin II in diabetic nephropathy: Emphasis on nonhemodynamic mechanismsCurrent Issues in Treating the Hypertensive Patient with Diabetes: Focus on Diabetic NephropathyDoxazosin Prevents Proteinuria and Glomerular Loss of Heparan Sulfate in Diabetic RatsLongitudinal evaluation of renal function in non-insulin-dependent diabetic patients with early nephropathy: Effects of angiotensin-converting enzyme inhibitionEffect of angiotensin-converting enzyme inhibition on nephropathy in patients with a remnant kidneyRenin-aldosterone axis in normoalbuminuric insulin-dependent diabetes mellitus patients with glomerular hyperfiltrationHypertension in Diabetic Patients: An Update of Interventional Studies to Preserve Renal FunctionIntroduction: Nature of microalbuminuria, proteinuria, and progressive renal diseaseTeratogen update: Angiotensin-converting enzyme inhibitorsGlucose and insulin levels during diuretic therapy in hypertensive men.Hypertension: Are Beta-Blockers and Diuretics Appropriate First-Line Therapies?ACE inhibitor mediated reductions in renal size and microalbuminuria in normotensive, diabetic subjects 15 April 1993Volume 118, Issue 8Page: 643-644KeywordsACE inhibitorsAngiotensin converting enzymeBlood pressureGlomerular filtration rateHypertensionMedical risk factorsMicroalbuminuriaRandomized trialsRenal diseasesType 2 diabetes Issue Published: 15 April 1993 CopyrightCopyright © 1993 by American College of Physicians. 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