What class of drug is preferred initially to reduce proteinuria in chronic kidney disease?

• A. Angiotensin receptor blockers
• B. Diuretics
• C. ACE inhibitors
• D. NSAIDs

Answer: (C)

Blockade of the renin-angiotensin system with ACE inhibitors is preferred first because these drugs lower intraglomerular pressure by dilating the efferent arteriole. This reduces the amount of protein leaking into the urine and helps slow the progression of chronic kidney disease, especially when proteinuria is present. The benefit in reducing proteinuria often occurs beyond just lowering blood pressure, making ACE inhibitors particularly renoprotective in proteinuric CKD.

If ACE inhibitors are not tolerated (for example, due to cough or risk of angioedema), an angiotensin receptor blocker serves as a strong alternative. Avoid combining ACE inhibitors with ARBs, as this does not provide additional renal protection and can increase risks. Diuretics can help manage edema and blood pressure but don’t reduce proteinuria as effectively. NSAIDs can worsen kidney function and increase proteinuric injury, so they’re not used for this purpose. When starting an ACE inhibitor, monitor kidney function and potassium, since small rises in creatinine are common and require careful follow-up.