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Few Ques. on diabetic nephropathy and it's treatment

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goal270

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Hi guys, If you could help me solve out a few doubts on this topic, it'd by great!
1. How do ACEI/ARB prevent nephropathy in diabetics?
2. If ARBs prevent nephropathy, then why don't aldosterone antagonists (Eplerenone) do that as well?
3. How do non-dihydropyridine CCB decrease proteinuria while dihydropyridine CCB don't?

All these questions are from the explanation of a UW question (Id : 151)
 

Diabeticketoacidosis

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Hi guys, If you could help me solve out a few doubts on this topic, it'd by great!
1. How do ACEI/ARB prevent nephropathy in diabetics?
2. If ARBs prevent nephropathy, then why don't aldosterone antagonists (Eplerenone) do that as well?
3. How do non-dihydropyridine CCB decrease proteinuria while dihydropyridine CCB don't?

All these questions are from the explanation of a UW question (Id : 151)
ACE/ARB are wonderful drugs. Diabetes causes sclerosis of efferent arteriole increasing GFR initiatilly but later on decreased depends in duration of disease. These drugs cause dilation of efferent arteriole thus decreasing GFR and increasing RBF that's why there is increase in creatinine initially in start of medications and also first dose hypotension bcz of decreased AT2. ACE are contraindicated in high creatinine bcz they further decrease in GFR. Aldosterone related treatment is not effective. We have to antagonize AT2 effects that are deleterious.
 
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