T. Keilani et al., SELECTED ASPECTS OF ACE-INHIBITOR THERAPY FOR PATIENTS WITH RENAL-DISEASE - IMPACT ON PROTEINURIA, LIPIDS AND POTASSIUM, Journal of clinical pharmacology, 35(1), 1995, pp. 87-97
Overt proteinuria is often accompanied by hypercholesterolemia and is
associated with increased lipoprotein(a) levels. These lipid abnormali
ties are probably involved in the high incidence of macrovascular comp
lications associated with diabetic nephropathy and possibly other kind
s of non-diabetic proteinuric renal disease. Over the last decade many
studies have shown that ACE inhibitors can reduce urinary protein exc
retion but little attention was paid to the impact of this form of the
rapeutic intervention on the lipid profile. In this article we review
our recent data showing that fosinopril administration was associated
with significant decreases in both urinary protein excretion, serum to
tal cholesterol levels, and plasma lp(a) levels. The use of ACE inhibi
tors in patients with renal impairment can result in the development o
f hyperkalemia as a result of suppression of angiotensin II-driven ald
osterone secretion by the adrenal gland. Inhibition of aldosterone sec
retion may depend on the degree of inhibition of angiotensin II format
ion in the circulation and also locally in the adrenal gland. Because
the various ACE inhibitors exhibit different degrees of ACE inhibition
at the tissue level, we have postulated that angiotensin II-dependent
aldosterone production will be inhibited to a lesser degree by agents
that have low tissue affinity for the adrenal gland. The implication
of this theoretical concept for the development of hyperkalemia in pat
ients with impaired renal function treated with ACE inhibitors is disc
ussed.