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- W1969702808 abstract "To the Editor: Recently, Suissa et al.1.Suissa S. Hutchinson T. Brophy J.M. et al.ACE-inhibitor use and the long-term risk of renal failure in diabetes.Kidney Int. 2006; 69: 913-919Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar reported that use of ACE inhibitors (ACEi) by hypertensive diabetic patients is not associated with a long-term decreased risk of end-stage renal disease. They suggest that ACEi while providing an early benefit to the kidney could in fact damage the kidney in the longer term by mechanisms still unknown. Experimental data from our group support the possibility of such adverse effects of renin–angiotensin system blockade on the kidney. In proteinuric rats, the combination of ACEi and a low sodium diet elicits pronounced renal interstitial damage, despite a significant reduction of proteinuria.2.Hamming I. Navis G. Kocks M. et al.ACE inhibition has adverse renal effects during dietary sodium restriction in proteinuric and healthy rats.J Pathol. 2006; 209: 129-139Crossref PubMed Scopus (45) Google Scholar As similar effects were found in healthy rats, the renal damage was not owing to particularities of the model, but related to the ACEi regimen. This is in line with earlier data in experimental renal transplantation, with monotherapy ACEi.3.Smit-van Oosten A. Navis G. Stegeman C.A. et al.Chronic blockade of angiotensin II action prevents glomerulosclerosis, but induces graft vasculopathy in experimental kidney transplantation.J Pathol. 2001; 194: 122-129Crossref PubMed Scopus (31) Google Scholar These data are distressing, as the ACEi regimens induced renal fibrosis in spite of a reduction in proteinuria and blood pressure, that is, an improvement of the established clinical criteria for a good response to therapy. In human, it is usually not feasible to monitor renal structural damage during therapy. Accordingly, considering the dissociation between renal fibrosis and the intermediate parameters blood pressure and proteinuria, therapy-associated progressive renal damage during renin–angiotensin system blockade in human cannot easily be recognized, and would require large, hard end point studies to become manifest. Although the mechanism underlying the ACEi-induced renal fibrosis deserves further study, our data provide a possible explanation for the increased risk of end-stage renal disease found by Suissa et al.1.Suissa S. Hutchinson T. Brophy J.M. et al.ACE-inhibitor use and the long-term risk of renal failure in diabetes.Kidney Int. 2006; 69: 913-919Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar The incidence of end-stage renal disease is increasing worldwide, despite extensive use of renin–angiotensin system blockers. It would be prudent not to take their long-term renoprotective effect for granted, scrutinize their effects on renal structural damage in experimental studies, and critically evaluate their outcome in human during long-term follow-up." @default.
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- W1969702808 date "2006-10-01" @default.
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- W1969702808 title "ACE inhibitor use and the increased long-term risk of renal failure in diabetes" @default.
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- W1969702808 doi "https://doi.org/10.1038/sj.ki.5001684" @default.
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