Spironolactone in Addition to ACE Inhibition to Reduce Proteinuria in Patients with Chronic Renal Disease

doi:10.1056/NEJM200109203451215

Volume 345:925-926		September 20, 2001		Number 12

Spironolactone in Addition to ACE Inhibition to Reduce Proteinuria in Patients with Chronic Renal Disease

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To the Editor: Angiotensin-converting–enzyme (ACE) inhibitorshave been shown to reduce proteinuria and slow the progressionof renal disease.¹ Although to date angiotensin II has beenthe focus of attention as the primary mediator of the renin–angiotensin–aldosteronesystem, several studies have raised the possibility that aldosteroneitself has a role in mediating progressive renal disease.²^,³Pitt et al.⁴ showed that blockade of aldosterone receptors byspironolactone significantly reduced the risk of morbidity anddeath among patients with heart failure who were already receivingACE inhibitors. The authors hypothesized that the benefits werenot due to the hemodynamic effects of spironolactone . . . [Full Text of this Article]

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