Meticulous blood pressure control, particularly with antiproteinuric medications, such as ACE inhibitors and angiotensin receptor blockers (ARBs), have proven to be effective in slowing the progression of kidney disease and are pillars in the modern management of chronic kidney disease (CKD). However, despite careful attention to blood pressure lowering and the use of ACEi and/or ARBs, progress...

Patients with diabetic renal disease have a very bad prognosis. Hyperfiltration, related to poor metabolic control, occurs early on in the disease process. There is also an increase in albumin excretion which can be readily reversed by eVective glycaemic control at clinical diagnosis (fig 1). A phase is then entered during which most patients are normoalbuminuric. However, after approximately 1...

Our opponents in this debate state that there are insufficient data to consider albuminuria as a valid target for therapy in patients with CKD. They base their opinion predominantly on two arguments: first, a decrease in albuminuria is not always associated with renoprotection, and second, no prospective randomized controlled trial has been conducted that really targeted albuminuria.

Blood pressure control reduces decline of kidney function. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers offer renoprotection to a small extent beyond that attributable to blood pressure lowering. These agents also reduce proteinuria, a risk marker for renal disease progression. Accumulating evidence indicates that their antiproteinuric effect correlates with their ...