Assessing long-term effects of MDMA (Ecstasy).

are that renal disease also activates the renin-angiotensin system, sympathetic drive is high, and the glomeruli overgrow and fibrose, resembling the terminally failing heart. Thus the next round of renal trials may need, besides an ACE inhibitor or ARB and very large numbers, new modifications to lessen mortality. Speculations could include spironolactone to further decrease proteinuria and to lessen fibrosis, with -blockers to dampen excess sympathetic stimulation. But instead of mounting giant and expensive trials to achieve the elusive reduction in mortality, the practical ideal in diabetic nephropathy could become early intervention, even before there is overt hypertension or proteinuria.