Renal perfusion and function. The implications of converting enzyme inhibition.

Because the kidney is both the source of circulating renin and the final determinant of the state of sodium balance, which in turn defines responsiveness to angiotensin II, one might have anticipated substantial interest in the impact of converting enzyme inhibitors on the kidney when these agents were developed. The lessons learned about the role of the renin-angiotensin system in normal renal perfusion and function, and possible disorders of control that contribute to disease in patients with essential hypertension, renovascular hypertension, and chronic progressive renal parenchymal disease are reviewed. In each case, the lessons here have important implications for the clinical application of converting enzyme inhibition.