Which class of medications is preferred initially to reduce proteinuria in chronic kidney disease?

• A. ACE inhibitors
• B. Beta blockers
• C. Diuretics
• D. NSAIDs

Answer: (A)

In chronic kidney disease, reducing proteinuria by lowering the pressure inside the glomeruli is a primary goal because it helps protect kidney function. ACE inhibitors do this by blocking angiotensin II, which normally constricts the efferent arteriole. With the efferent arteriole dilated, glomerular pressure drops, less protein leaks into the urine, and kidney protection improves over time. This antiproteinuric, renoprotective effect is why ACE inhibitors are favored as the initial therapy when proteinuria is present. If ACE inhibitors aren’t tolerated, ARBs provide a similar benefit. Other options like beta blockers or diuretics don’t directly reduce proteinuria, and NSAIDs can worsen kidney function. Monitor for potential hyperkalemia and changes in kidney function while using these medications.