Ettore Guidi1, Enrico E Minetti, Maria Grazia Cozzi. 1. Centro di Ricerca Clinica in Nefrologia e Ipertensione Arteriosa, Unità Operativa di Nefrologia, Dialsi e Terapia del Trapianto Renale, Ospedale Niguarda, Milano, Italy. etguid@tin.it
Abstract
BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are the drugs of choice for the treatment of hypertension in patients with non-diabetic nephropathies. However, not every trial has reported better results with ACE inhibitors (ACE-I) than with other drugs. This study investigates whether the acute and chronic effects of ACE inhibition on renal and glomerular haemodynamics are similar in glomerular and interstitial nephropathies. METHODS: We studied 20 hypertensive patients, on their usual diet, with mild-to-moderate chronic renal failure secondary to non-diabetic nephropathy. After a three-week wash out period, we determined plasma clearances of para-amino-hippurate and inulin before, and after acute oral administration of either enalapril or ramipril. This same test was carried out after one and two years of treatment with the same drug. RESULTS: Acute ACE inhibition causes a decrease of renal perfusion, glomerular filtration and pressure with an increase of afferent resistances. Long-term ACE inhibition is associated only with a decrease in renal perfusion, with a non-significant tendency to higher filtration fraction and lower afferent resistances. All the renal haemodynamic modifications mentioned above are present only in patients with glomerular diseases. CONCLUSIONS: Renal and glomerular haemodynamic responses are not similar after acute and chronic ACE inhibition. Only patients with glomerular diseases show acute or long-term responses to ACE inhibition.
BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors are the drugs of choice for the treatment of hypertension in patients with non-diabetic nephropathies. However, not every trial has reported better results with ACE inhibitors (ACE-I) than with other drugs. This study investigates whether the acute and chronic effects of ACE inhibition on renal and glomerular haemodynamics are similar in glomerular and interstitial nephropathies. METHODS: We studied 20 hypertensivepatients, on their usual diet, with mild-to-moderate chronic renal failure secondary to non-diabetic nephropathy. After a three-week wash out period, we determined plasma clearances of para-amino-hippurate and inulin before, and after acute oral administration of either enalapril or ramipril. This same test was carried out after one and two years of treatment with the same drug. RESULTS: Acute ACE inhibition causes a decrease of renal perfusion, glomerular filtration and pressure with an increase of afferent resistances. Long-term ACE inhibition is associated only with a decrease in renal perfusion, with a non-significant tendency to higher filtration fraction and lower afferent resistances. All the renal haemodynamic modifications mentioned above are present only in patients with glomerular diseases. CONCLUSIONS: Renal and glomerular haemodynamic responses are not similar after acute and chronic ACE inhibition. Only patients with glomerular diseases show acute or long-term responses to ACE inhibition.
Authors: Sushrut S Waikar; Venkata Sabbisetti; Johan Ärnlöv; Axel C Carlsson; Josef Coresh; Harold I Feldman; Meredith C Foster; Gudeta D Fufaa; Johanna Helmersson-Karlqvist; Chi-Yuan Hsu; Paul L Kimmel; Anders Larsson; Yumin Liu; Lars Lind; Kathleen D Liu; Theodore E Mifflin; Robert G Nelson; Ulf Risérus; Ramachandran S Vasan; Dawei Xie; Xiaoming Zhang; Joseph V Bonventre Journal: Nephrol Dial Transplant Date: 2016-06-07 Impact factor: 5.992