This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetic nephropathy is the most common cause of end-stage renal disease in the United States. Activation of the renin-angiotensin-aldosterone system (RAAS) plays a major role in the development and progression of diabetic nephropathy. A major question is whether combinations drugs that inhibit the RAAS at multiple levels can reduce further improve renal outcome as compared to standard drug therapy with an ACEi-based regimen. The study will test the hypothesis that additive blockade of renin-angiotensin-aldosterone system beyond ACE inhibition decreases proteinuria and slows progression of renal disease in diabetics with overt nephropathy by suppressing or blocking aldosterone.
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