How do ACE inhibitors act to protect kidney function in the setting of HIV-associated nephropathy?

Bottom line:  ACE inhibitors protect kidney function by decreasing glomerular capillary pressure and by reducing exposure to proteins which could cause proliferation of mesangial cells and matrix.

Summary:  According to Goodman & Gilman’s Pharmacological Basis of Therapeutics [AccessMedicine], ACE inibitors mitigate glomerular injury by decreasing arterial blood pressure and dilating renal efferent arterioles, both of which decrease glomerular capillary pressure.  ACE inhibitors also increase “permeability selectivity of the filtering membrane” which then reduces exposure of the mesangium to proteins, which could stimulate mesangial cell and matrix production.  Reduced intrarenal levels of AngII can also inhibit mesangial cell growth.


About Amy

Clinical Informationist at EUH Branch Library
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