Lowering asymmetric dimethylarginine--a new mechanism mediating the renoprotective effects of renin-angiotensin system inhibitors in proteinuric patients?

the ACE inhibitor and the ARB lead to similar improvements of the biochemical markers as well as to enhancement of flow-mediated vasodilation. Interestingly, at baseline, the degree of proteinuria was independently related to ADMA and SDMA levels. Moreover, logistic regression analysis suggested that the 35% drop in ADMA levels in this study was related to the improvement of proteinuria. Despite all the limitations of this nonrandomized uncontrolled study, the authors point out a new and potentially important pathway by which proteinuria and renal injury could be linked. A reduction of proteinuria by blocking the renin-angiotensin system could cause a decrease in ADMA (and SDMA), potentially increasing the bioavailability of nitric oxide. This effect seems to be independent of the changes in blood pressure.