Abstract
Diabetic nephropathy is the most important cause of end-stage renal failure. Angiotensin converting enzyme inhibitors (ACE) and angiotensin antagonists (sartans) decrease in patients with type 2 diabetes the risk of developing microalbuminuria and clinical proteinuria and slow down the rate of loss of the glomerular filtration rate in patients with diabetic nephropathy.
Despite that diabetic nephropathy develops in the majority of microalbuminuric patients. Combination of ACE inhibitors and sartans probably does not have greater antiproteinuric effect compared to monotherapy with ACE inhibitors.
On the other hand, renin inhibitor, aliskiren, in recently published study further decreased albuminuria in patients with diabetic nephropathy treated with the maximal dose of the angiotensin antagonist. Further studies should demonstrate if this additive antiproteinuric effect also translates into increased long-term renoprotection.