We report that the inhibition of the angiotensin converting enzyme is an effective short-term treatment

of low-renin hypertension in acute glomerulonephritis (AGN). We treated 9 patients who had AGN with
moderate to severe hypertension and suppressed plasma renin activity with 25-50 mg of captopril per
os every 6-8 hours. Control of blood pressure was achieved in 1-2 hours and maintained thereafter.
Captopril therapy was associated with an increase in plasma renin activity, a decrease in plasma
aldosterone and an increase in the urinary excretion of prostaglandin E2 and kallikrein, independent of
changes in urine output. Creatinine clearance increased 39.6 +/- SE 15.2% with captopril and decreased
in the postcaptopril period, suggesting that captopril exerted a reversible effect on glomerular filtration
rate, possibly modifying intrarenal vasoconstriction. Our study shows that rapid control of hypertension
in AGN may be obtained with oral inhibition of the angiotension converting enzyme. Stimulation of PGE2
and kinins, as well as angiotensin II blockade appear to contribute to the hypotensive effect of the drug;
by inference, the suppressed activity of vasodilator systems seems to play a significant role in the
hypertension of AGN.

In summary, the combination of an ACE inhibitor/angiotensin receptor blocker with a calcium channel
blocker (long-acting dihydropyridine or non-dihydropyridine) and a diuretic may be effective to attain
the target BP and to reduce the amount of urinary protein excretion in patients with chronic GN.

Guidelines for the management of hypertension in CKD are that for diabetic and non diabetic
proteinuric patients with CKD, anti-hypertensive therapy should include ACEI or ARB. For patients with
non diabetic nonproteinuric CKD, anti-hypertensive therapy should include either ACEI, ARB, diuretic, b-
blocker, or longacting CCB61,62. These drugs should be used with caution, with strict monitoring of the
renal function and plausibly temporarily withdrawn during situations of low renal flow (e.g. major
surgeries, hypovolemic situations).

Recommendation: Nifedipine should be used in controlling hypertension in acute post streptococcal

glomerulonephritis.