A 50 years old male with 2 diabetes mellitus is found to have 24 hour urinary albumin of 250 mg. Which of the following drugs may be used to retard progression of renal disease –
**Core Concept**
The management of diabetic nephropathy involves the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to reduce proteinuria and slow the progression of renal disease. This concept is crucial in the treatment of patients with diabetes mellitus and evidence of renal involvement.
**Why the Correct Answer is Right**
Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, works by blocking the conversion of angiotensin I to angiotensin II, thereby reducing the levels of aldosterone and decreasing the pressure within the glomerular capillaries. This reduction in glomerular pressure decreases the amount of albumin that is filtered into the urine, thereby reducing proteinuria. Additionally, ACE inhibitors have been shown to have beneficial effects on the cardiovascular system, including the reduction of blood pressure and the prevention of cardiac remodeling.
**Why Each Wrong Option is Incorrect**
**Option A:** Hydrochlorothiazide is a diuretic that can increase the glomerular filtration rate, potentially worsening proteinuria in patients with diabetic nephropathy.
**Option C:** Amiloride is a potassium-sparing diuretic that can be used to treat hypertension, but it does not have the same renoprotective effects as ACE inhibitors in patients with diabetic nephropathy.
**Option D:** Aspirin is an antiplatelet agent that is used to prevent cardiovascular events, but it does not have a role in the treatment of diabetic nephropathy.
**Clinical Pearl / High-Yield Fact**
ACE inhibitors should be used as the first-line treatment for patients with diabetic nephropathy, as they have been shown to reduce the risk of end-stage renal disease and cardiovascular events.
**✓ Correct Answer: B. Enalapril**