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25 Cards in this Set

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captopril
ACE inhibitor
enalopril
ACE inhibitor
Reduce glomerular capillary pressure by inhibition of angiotensin II concentrations
ACE inhibitor
associated with slower decline in CrCl, decrease proteinuria (35-60% vs. placebo) and subsequently progression of kidney disease
ACE inhibitor
Strongest clinical outcomes are in patients with Type 1 diabetes with albuminuria or proteinuria.
ACE inhibitor
losartan
Angiotensin II Receptor Blockers
ibersartan
Angiotensin II Receptor Blockers
Selective inhibition of angiotensin II at the AT1 receptor
Angiotensin II Receptor Blockers
reduction of proteinuria (30-60% vs. placebo) independent of systemic blood pressure reduction
Angiotensin II Receptor Blockers
Agents that block the AT1 receptors has been promoted to provide more complete attenuation of the angiotensin II action, particularly because non ACE pathways, such as, chymases and endopeptidases can generate angiotensin II
Angiotensin II Receptor Blockers
decrease tissue angiotensin II to a greater extent than either agent alone
ACEi and ARB combination therapy
Human studies to date confirm decrease urinary albuminuria/ proteinuria by 25-45% in patients with Type 1 and Type 2 DM compared to monotherapy with ACEi or ARB.
ACEi and ARB combination therapy
non-dihydropyridines (NDHCCB
Calcium channel blockers
diltiazem
Calcium channel blockers
verapamil
Calcium channel blockers
significant dilation at the afferent arteriole resulting in loss of renal autoregulation
calcium channel blocker
dihydropyridines (DHCCB)
(amlodipine and felodipine)
increase intraglomerular capillary pressure and may increase proteinuria
DHCCB class
(amlodipine and felodipine)
reduce glomerular pressure and reduce proteinuria
calcium channel blocker
NDHCCB
Microalbuminuria is the strongest independent predictor for developing ESRD
just a fact
Lower urinary protein excretion rates dramatically
ACE and ARBs
Reduce relative risk for doubling of Scr or developing ESRD
ACE and ARBs
Benefit associated with these agents is independent of their anti-hypertensive effect: increase dose to maximum effect
ACE and ARBs
• Uncontrolled chronic hyperglycemia leads to accumulation of glycosylated endproducts in the glomerulus increase glomerular filtration and increase proteinuria
Diabetes Mellitus
Strict blood glucose control decrease risk of microalbuminuria and proteinuria by 34-56%, respectively in the above trials
Diabetes Mellitus
Adverse lipoprotein profile has been associated with a higher prevalence and advance rate of CKD
Dyslipidemia