We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Chronic Renal Disease

Pieter M. ter Wee, MD; Murray Epstein, MD
Arch Intern Med. 1993;153(15):1749-1759. doi:10.1001/archinte.1993.00410150027003.
Text Size: A A A
Published online


In recent years, considerable attention has focused on the possibility that some classes of antihypertensive agents may confer a greater renoprotective effect in retarding the progression of chronic renal insufficiency. Experimental studies in rats have demonstrated that the sustained increase in glomerular capillary pressure evoked in response to loss of renal mass produces a destructive sclerosing reaction. Administration of angiotensin-converting enzyme inhibitors decreases glomerular capillary pressure with a resultant reduction of glomerular sclerosis, suggesting that angiotensin-converting enzyme inhibitor therapy may protect the injured kidney from hemodynamically mediated glomerular damage. On the basis of these experimental observations, many studies have attempted to investigate whether angiotensin-converting enzyme inhibitors can slow the progression of chronic renal disease in humans. We surveyed the literature critically and concluded that, the data from animals notwithstanding, the majority of studies in humans have been nonrandomized, of too short duration, or confounded by investigative difficulties. Therefore, we cannot yet conclude that angiotensin-converting enzyme inhibitors modify the rate at which renal disease progresses in nondiabetic patients.

(Arch Intern Med. 1993;153:1749-1759)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

34 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.