This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (99)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Garry P. Reams, MD; John H. Bauer, MD

Arch Intern Med. 1986;146(11):2145-2148.

Abstract
• The purpose of this study was to define the effect of the angiotensin-converting enzyme inhibitor, enalapril maleate, on blood pressure, renal function, protein excretion, and potassium homeostasis in patients with hypertension associated with moderate to severe renal dysfunction. Nine patients, having an initial inulin clearance between 9 and 48 mL/min/1.73 m², were treated with enalapril monotherapy (n = 6) or enalapril/furosemide (n = 3) combination therapy. Systolic and diastolic blood pressures were well controlled. Supine plasma renin activity was stimulated; the supine plasma aldosterone level was suppressed, with a resultant increase in the serum potassium level. Clinical hyperkalemia was not observed. Glomerular filtration rate, assessed by inulin and creatinine clearances, was not significantly changed. Effective renal plasma flow, assessed by paraaminohippurate clearance was significantly increased, with a resultant decrease in filtration fraction. Importantly, urinary protein excretion was markedly reduced. These results suggest that enalapril therapy produces efferent arteriolar dilitation with preservation of the glomerular filtration rate. Enalapril therapy may also blunt the effects of angiotensin II on transglomerular passage of protein, as demonstrated by reduced proteinuria. These findings suggest that interruption of the renin-angiotensin system in patients with preexisting renal disease may have renal protective effects.

(Arch Intern Med 1986;146:2145-2148)

Author Affiliations
From the Department of Medicine, Division of Nephrology, University of Missouri School of Medicine, Columbia.

Footnotes
Accepted for publication March 10, 1986.

Reprint requests to Department of Medicine, Hypertension Section (Room N-406), University of Missouri School of Medicine, Columbia, MO 65212 (Dr Reams).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Risk of Hyperkalemia in Nondiabetic Patients With Chronic Kidney Disease Receiving Antihypertensive Therapy
Weinberg et al.
Arch Intern Med 2009;169:1587-1594.
ABSTRACT | FULL TEXT  

Aldosterone Activates NF-{kappa}B in the Collecting Duct
Leroy et al.
J. Am. Soc. Nephrol. 2009;20:131-144.
ABSTRACT | FULL TEXT  

Increased Expression of Mineralocorticoid Effector Mechanisms in Kidney Biopsies of Patients With Heavy Proteinuria
Quinkler et al.
Circulation 2005;112:1435-1443.
ABSTRACT | FULL TEXT  

Aldosterone in Chronic Kidney and Cardiac Disease
Hostetter and Ibrahim
J. Am. Soc. Nephrol. 2003;14:2395-2401.
ABSTRACT | FULL TEXT  

Hyperkalemia, Renal Failure, and Converting-Enzyme Inhibition: An Overrated Connection
Garcia et al.
Hypertension 2001;38:639-644.
ABSTRACT | FULL TEXT  

Role of Aldosterone in Renal Vascular Injury in Stroke-Prone Hypertensive Rats
Rocha et al.
Hypertension 1999;33:232-237.
ABSTRACT | FULL TEXT  

Chronic Renal Insufficiency: A Diagnostic and Therapeutic Approach
Rahman and Smith
Arch Intern Med 1998;158:1743-1752.
ABSTRACT | FULL TEXT  

Angiotensin-Converting Enzyme Inhibition and Renal Protection: An Assessment of Implications for Therapy
Hollenberg and Raij
Arch Intern Med 1993;153:2426-2435.
ABSTRACT  

Angiotensin Converting Enzyme Inhibitors and Progressive Renal Insufficiency: Current Experience and Future Directions
Keane et al.
ANN INTERN MED 1989;111:503-516.
ABSTRACT  

Efficacy and Renal Effects of Enalapril Therapy for Hypertensive Patients With Chronic Renal Insufficiency
Abraham et al.
Arch Intern Med 1988;148:2358-2362.
ABSTRACT  

Enalapril Therapy in Patients With Renal Function Impairment
Bear
Arch Intern Med 1988;148:2343-2344.
ABSTRACT  

Renal Protective Effect of Strict Blood Pressure Control With Enalapril Therapy
Bauer et al.
Arch Intern Med 1987;147:1397-1400.
ABSTRACT