In chronic kidney disease with albuminuria, which therapy slows disease progression?

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

Answer: (C)

In chronic kidney disease with albuminuria, the therapy that slows progression is agents that block the renin-angiotensin system. ACE inhibitors and ARBs reduce intraglomerular pressure by dilating the efferent arteriole, which lowers glomerular capillary pressure, decreases protein leakage into the urine, and diminishes hyperfiltration injury. This not only lowers albuminuria but also protects nephron function over time, slowing the decline in GFR and the progression toward end-stage kidney disease. Their benefits extend beyond blood pressure reduction, including anti-fibrotic and anti-inflammatory effects that help preserve kidney structure. Other options can help control blood pressure or volume status, but they don’t slow nephron injury as effectively or reduce proteinuria to the same extent.