Lisinopril kidney disease
Pro Research Analysisby 
Searched over 200M research papers
The Impact of Lisinopril on Kidney Disease
Introduction to Lisinopril and Kidney Disease
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to manage hypertension and heart failure. Its role in kidney disease, particularly in diabetic nephropathy and other chronic kidney conditions, has been extensively studied. This article synthesizes research findings on the effects of lisinopril on kidney function, focusing on diabetic nephropathy, autosomal dominant polycystic kidney disease (ADPKD), and non-diabetic nephropathies.
Lisinopril in Diabetic Nephropathy
Comparative Studies with Atenolol
Several studies have compared the efficacy of lisinopril with other antihypertensive agents like atenolol in patients with diabetic nephropathy. Research indicates that both lisinopril and atenolol effectively reduce blood pressure and slow the decline in kidney function in hypertensive non-insulin-dependent diabetes mellitus (NIDDM) patients with diabetic nephropathy. However, lisinopril has shown a more significant reduction in urinary albumin excretion, a marker of kidney damage, compared to atenolol 16.
Genetic Factors and Lisinopril Efficacy
The effectiveness of lisinopril can also be influenced by genetic factors. A study on insulin-dependent diabetes mellitus (IDDM) patients found that those with the II genotype of the ACE gene experienced a more pronounced reduction in albumin excretion rate (AER) when treated with lisinopril compared to those with other genotypes 2. This suggests that genetic profiling may help predict the response to lisinopril in diabetic nephropathy.
Early Intervention Benefits
Lisinopril has been shown to slow the progression of renal disease even in normotensive IDDM patients with normoalbuminuria or microalbuminuria. The greatest benefits were observed in patients with microalbuminuria, indicating that early intervention with lisinopril can be particularly beneficial in preventing the progression of kidney disease 310.
Lisinopril in Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Blood Pressure Control and Kidney Volume
In patients with early ADPKD, rigorous blood pressure control using lisinopril, either alone or in combination with telmisartan, was associated with a slower increase in total kidney volume and a greater reduction in urinary albumin excretion. However, the combination therapy did not significantly alter the rate of increase in total kidney volume compared to lisinopril alone 48.
Long-Term Outcomes
Long-term studies have shown that monotherapy with lisinopril effectively controls blood pressure and slows the decline in estimated glomerular filtration rate (GFR) in ADPKD patients. The addition of an angiotensin II-receptor blocker (ARB) like telmisartan did not provide additional benefits in terms of GFR decline 8.
Lisinopril in Non-Diabetic Nephropathies
Proteinuria and Renal Function
In patients with non-diabetic chronic renal diseases and mild proteinuria, lisinopril has been found to be more effective than other antihypertensive agents in slowing the progression of renal insufficiency. This renoprotective effect is attributed to the specific action of ACE inhibitors beyond blood pressure control 9.
Kidney Transplant Recipients
In hypertensive kidney transplant recipients treated with cyclosporin, lisinopril was compared with nifedipine. While both drugs were effective in managing hypertension, nifedipine showed a more significant improvement in kidney transplant function over a period of two years 7.
Conclusion
Lisinopril plays a crucial role in managing kidney disease, particularly in diabetic nephropathy and ADPKD. Its benefits include significant reductions in urinary albumin excretion and slower progression of renal insufficiency. Genetic factors may influence its efficacy, and early intervention can yield substantial benefits. While combination therapies with ARBs do not always provide additional advantages, lisinopril remains a cornerstone in the treatment of various kidney diseases.
Sources and full results
Most relevant research papers on this topic
Long-Term Effect of Lisinopril and Atenolol on Kidney Function in Hypertensive NIDDM Subjects With Diabetic Nephropathy
Both lisinopril and atenolol effectively reduce kidney function decline in hypertensive NIDDM patients with diabetic nephropathy.
RCT
Highly CitedEffect of angiotensin-converting enzyme (ACE) gene polymorphism on progression of renal disease and the influence of ACE inhibition in IDDM patients: findings from the EUCLID Randomized Controlled Trial. EURODIAB Controlled Trial of Lisinopril in IDDM.
ACE inhibitor treatment can slow renal disease progression in type II diabetes mellitus patients, with lisinopril showing the most significant benefit for this group.
RCT
Large Human TrialHighly CitedRandomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria
Lisinopril slows the progression of renal disease in normotensive insulin-dependent diabetes patients with little or no albuminuria, with the greatest effect in those with microalbuminuria (AER 20 g/min).
RCTLarge Human TrialHighly CitedBlood pressure in early autosomal dominant polycystic kidney disease.
In early ADPKD, rigorous blood-pressure control with lisinopril and telmisartan leads to a slower increase in total kidney volume, no overall change in estimated GFR, and a greater decline in left-ventricular-mass index.
RCTLarge Human TrialHighly CitedMO069: Therapeutic Effects of Semaglutide as Mono and Combination Treatment with Lisinopril in a Mouse Model of Hypertension-Accelerated Diabetic Kidney Disease
Semaglutide, alone or combined with lisinopril, significantly improves blood pressure, albuminuria, and glomerulosclerosis in a mouse model of hypertension-accelerated diabetic kidney disease.
RCTImpact of Lisinopril and Atenolol on Kidney Function in Hypertensive NIDDM Subjects With Diabetic Nephropathy
Lisinopril effectively reduces albuminuria more than atenolol in hypertensive NIDDM patients with diabetic nephropathy, potentially improving kidney function.
RCTHighly CitedSustained improvement of renal graft function for two years in hypertensive renal transplant recipients treated with nifedipine as compared to lisinopril.
Nifedipine improves kidney transplant function more effectively than lisinopril over a 2-year period in hypertensive renal transplant patients treated with cyclosporin.
RCTHighly CitedAngiotensin blockade in late autosomal dominant polycystic kidney disease.
Monotherapy with an ACE inhibitor effectively controls blood pressure in most patients with autosomal dominant polycystic kidney disease and stage 3 chronic kidney disease, while adding an ARB does not alter the decline in estimated GFR.
RCTLarge Human TrialHighly CitedEffect of Lisinopril on the progression of renal insufficiency in mild proteinuric non-diabetic nephropathies.
Lisinopril has a specific renoprotective effect in addition to blood pressure control in patients with mild proteinuria, slowing the progression of non-diabetic chronic renal diseases.
RCT