Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers MS, PA-C

Second Advisor

Rob Rosenow PharmD, OD

Abstract

Background: Monotherapy treatment with either angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin type I receptor antagonists (ARBs) has been shown to be renoprotective in patients with Diabetes Mellitus Type II (DM II). Dual blockade of the renin angiotensin system (RAS) with the combination of ACE-Is and ARBs in these same patients might provide further benefit.

Methods: Exhaustive search of available medical literature using the search engines, Medline, CINAHL, and Science Citation Index Expanded. Articles were included which used multiple measurements of kidney function and patients with varying levels of kidney function.

Results: After using the exclusion criteria, a collection of articles was narrowed to 6 studies. All articles proved a decrease in proteinuria and short term benefit in renal function. One article demonstrated long term harm to the kidneys.

Conclusion: Dual blockade of RAS reveals short term improvement of renal function which in the long term might have adverse effects on the kidneys. In the future longer term studies should be done to prove or disprove the benefits on kidney health. If dual therapy is beneficial then providers will be able to prescribe ACE-Is and ARBs together to protect the kidneys in DM II patients.

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