In chronic kidney disease, which therapy can slow progression in patients with albuminuria?

• A. Beta-blockers
• B. ACE inhibitors or ARBs
• C. Loop diuretics
• D. Calcium channel blockers

Answer: (B)

In chronic kidney disease with albuminuria, therapies that block the renin-angiotensin system slow kidney damage by reducing pressures inside the glomerulus and the amount of protein leaking into the urine. ACE inhibitors and ARBs achieve this by dilating the efferent arteriole, which lowers intraglomerular pressure and decreases albuminuria. That antiproteinuric effect correlates with a slower decline in kidney function and delayed progression to end-stage disease. They also help control blood pressure, which adds kidney protection, but the key benefit here is the reduction of protein leakage and glomerular hypertension from RAAS blockade.