Need some help

[jackster21]

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I understand that when you give an ace inhibitor or an arb proteinuria will decrease. Why is it that after an initial decrease, proteinuria will increase again while the pt continues to take these drugs?

Could somebody please point me in the right direction on this one? Please don't answer it. Some helpful hints would be nice.

 

[ForcedEntry]

Why is there proteinuria?

Do most drugs cure or treat?

 

[jackster21]

After doing some research I think I have it figured out. Initially, ace inhibitors decrease renal-vascular resistance and improve perfusion through the kidney, so there is an initial drop in proteinuria.

Then:

Angiotensin II stimulates glucocorticoid biosynthesis. Glucocorticoids regulate protein synthesis. Ace inhibitors prevent angiotensin II from being made, so glucocorticoids are not made and there is "overproduction" of protein.

Does that sound correct?

 

[Praziquantel86]

After doing some research I think I have it figured out. Initially, ace inhibitors decrease renal-vascular resistance and improve perfusion through the kidney, so there is an initial drop in proteinuria.

Then:

Angiotensin II stimulates glucocorticoid biosynthesis. Glucocorticoids regulate protein synthesis. Ace inhibitors prevent angiotensin II from being made, so glucocorticoids are not made and there is "overproduction" of protein.

Does that sound correct?

That's a part of it, but there is a much simpler (and more dominant) mechanism. Think about the initial disease process, and then think about what the drugs you mentioned do. Specifically, think about the natural history of the disease if no treatment were provide; and then think of the effects of the drugs on the disease process, and you'll have your answer.

 

[jackster21]

This?

http://ndt.oxfordjournals.org/cgi/content/full/22/1/5