Figure 610

Angiotensin-converting enzyme (ACE) inhibitors and low-dose triple therapy. The effects of ACE inhibitors are compared with those of low-dose triple therapy on systemic and glomerular pressure, proteinuria, and morphologic evidence of glomerular injury in rats with remnant kidneys. Both ACE inhibitors and triple therapy caused similar reductions in mean arterial pressure in rats with remnant kidneys; however, glomerular pressure declined only in the group treated with ACE inhibitors, by approximately 10 mm Hg. ACE inhibitor—induced reductions in systemic and glomerular pressure were associated with a reduction in protein-uria and morphologic evidence of glomerular injury. The data suggest that ACE inhibitors are superior to low-dose triple therapy in preventing glomerular injury in chronic renal disease. The data support the importance of increased glomerular pressure as a determinant of glomerular injury. ACE inhibitors may be more effective than are other agents, specifically because of their ability to reduce glomerular pressure. It should be noted, however, that significant reductions in glomerular pressure and injury may be achieved even with the triple-therapy regimen when significantly higher doses than those used in the current study are administered (see Figs. 6-5 and 6-6). Asterisk indicates P < 0.05 versus remnant. (Data from Anderson and coworkers [10].)

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