ACEI AND ARB: NEPHROPROTECTION IN CHRONIC KIDNEY DISEASE

Abstract

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are widely used in the treatment of chronic kidney disease (CKD), in addition to their use in systemic arterial hypertension (SAH), due to their positive effects on renal function. This study aimed to understand the mechanisms that justify their use, as well as the profile of patients who benefit the most. For this purpose, a literature review was conducted in the Google Scholar, SciELO, and PubMed databases using the keywords "Nephroprotection," "Angiotensin-Converting Enzyme Inhibitors," "Angiotensin Receptor Blockers," "ACEIs," and "ARBs." Articles in Portuguese published between 2021 and 2025 were selected. Nephroprotection with ACEIs occurs primarily by reducing intrarenal pressure, dilating the efferent arteriole in the glomeruli, and decreasing the production of angiotensin II, a potent vasoconstrictor. These factors prevent excessive pressure in the kidneys, avoiding long-term damage to renal tissue and, consequently, slowing the progression of chronic kidney conditions such as diabetic nephropathy and hypertensive kidney disease. ARBs are also effective drugs for nephroprotection, as they block the effects of angiotensin II. Additionally, both ARBs and ACEIs have shown efficacy in reducing proteinuria, a key indicator of kidney injury, helping to preserve renal function and delay the progression of chronic kidney disease. These medications are particularly useful in patients with comorbidities such as type 2 diabetes and hypertension, where proper blood pressure control and renal protection are essential to improve quality of life and prevent serious complications. While ACEIs and ARBs are highly beneficial for nephroprotection, they must be used cautiously due to the risks associated with the concomitant use of both drug classes, as hyperkalemia, hypotension, and acute kidney injury are possible complications.