Long term ACE inhibitor therapy may retard the progression of

Prolonged ACE inhibitor therapy has been found to prevent or delay end-stage renal disease in type I as well as type II diabetics. Albuminuria (an index of glomerulopathy) remains stable in those treated with ACE inhibitor, but aggravates in untreated diabetics. Treated patients have higher creatinine clearance, require less dialysis and have longer life expectancy. Benefits appear to be due to haemodynamic (systemic and intrarenal) as well as abnormal mesangial cell growth attenuating effects of ACE inhibitors. They reduce intraglomerular pressure and hyperfiltration. ACE inhibitors arrest/paly reverse any degree of albuminuria, but benefits in type 2 diabetics are rather limited once macroalbuminuria has set in. The RAS seems to accentuate micro- and macrovascular complications in diabetics, and ACE inhibitors have specific organ protective effect by attenuating the same. All patients with diabetic nephropathy, whether hypeensive or normotensive, deserve ACE inhibitor therapy. Deterioration of retinopathy in diabetics also appears to be retarded by ACE inhibitors. Ref:- kd tripathi; pg num:-505