A 3-year-old boy presented with dark-colored urine for 4months. His history was negative for infections, but he was taking oral methylcobalamin treatment for a persistent deficiency. His parents were first-degree cousins, and a female cousin had proteinuria of unknown etiology. A physical examination and laboratory examination revealed no abnormalities except for non-orthostatic nephritic proteinuria and low levels of vitamin B12. Albumin was the main protein in the urine. Kidney biopsy showed nonspecific changes. Genetic analysis identified a homozygous pathogenic AMN mutation, confirming Imerslund-Grâsbeck syndrome (IGS). Angiotensin-converting enzyme inhibitor was prescribed but discontinued due to stable protein levels. After 4years, kidney function remained stable. Imerslund-Grâsbeck syndrome is a rare autosomal recessive disorder that affects vitamin B12 and protein, particularly albumin absorption. While typically presenting with megaloblastic anemia, AMN mutations show variable phenotypes. Proteinuria is resistant to ACE inhibitors, and currently, there is no specific treatment.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for postoperative pain management after hip and knee arthroplasties but have been associated with renal adverse effects. The risk may increase when NSAIDs are combined with diuretics and angiotensin converting enzyme (ACE) inhibitors or Angiotensin-II-receptor antagonists. The aim of this substudy is to assess potential renal adverse effects of an eight-day postoperative treatment with ibuprofen in patients undergoing hip or knee arthroplasty during 90-days follow-up. This substudy is part of the PERISAFE trial-a randomized, placebo-controlled, blinded multicenter trial including 2904 patients undergoing hip or knee arthroplasty. Patients are randomized to receive either ibuprofen 400 mg three times daily or identical placebo three times daily for 8 days postoperatively. The primary outcome is the number of patients with renal dysfunction according to RIFLE criteria Level 1-5, at any point during the 90-day follow-up. The substudy is powered at 86.3% to detect or discard a 40% relative risk reduction in the placebo group, assuming an incidence of acute renal injury of 6.2%. The ethical approval for this substudy is included in the main PERISAFE trial, which has been approved by the Danish Medicine Agency, the National Committee on Health Research Ethics (EU CT no. 2022-502502-32-00), and the Danish Data Protection Agency (REG-149-2022).

Pharmacotherapy combinations have been shown to improve survival and reduce hospitalisations in adults with chronic heart failure with reduced ejection fraction (HFrEF); however, their cost-effectiveness when used as first-line treatment remains uncertain. A lifetime cohort Markov model was developed from the perspective of the NHS in England to assess the cost-effectiveness of five first-line pharmacotherapy combinations: (i) angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) and beta-blocker (BB) (NICE-recommended treatment at the time of analysis); (ii) ACEI/ARB, BB and mineralocorticoid receptor antagonists (MRA); (iii) angiotensin receptor-neprilysin inhibitor (ARNI), BB and MRA; (iv) ACEI/ARB, BB, MRA and sodium-glucose cotransporter-2 inhibitor (SGLT2i); and (v) ARNI, BB, MRA and SGLT2i. Baseline hospitalisation and mortality rates were informed by real-world data, while treatment effects (HRs) were derived from a review of randomised controlled trials. Among individuals able to tolerate an ACEI, the combination of ACEI, BB, MRA and SGLT2i (cost, £12 124; quality-adjusted life years (QALYs), 5.72) was found to be the most cost-effective first-line treatment option with an incremental cost-effectiveness ratio (ICER) of £7699.Among individuals unable to tolerate an ACEI, the combination of ARNI, BB, MRA and SGLT2i (cost, £18 950; QALYs, 6.04) was found to be the most cost-effective first-line treatment option with an ICER of £15 821. The next most cost-effective first-line treatment option was the combination of ARB, BB, MRA and SGLT2i (cost, £11 842; QALYs, 5.59). These findings were primarily driven by the greater relative QALY gain of ARNI compared with ARB. This study demonstrates that a first-line quadruple pharmacotherapy combination is cost-effective compared with a stepwise approach for treating people with HFrEF, suggesting that wider adoption of early initiation of quadruple pharmacotherapy may improve health outcomes and optimise healthcare resource use.

In patients with heart failure with reduced ejection fraction (HFrEF), target-dose (vs. below-target-dose) angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) improve clinical outcomes but worsen kidney function. Less is known about their effect on kidney failure (KF), especially in those with advanced chronic kidney disease (CKD), the examination of which was the objective of our study. Of the 154,945 Veterans with HFrEF (EF≤40%) and no baseline KF, 134,046 were initiated on ACEIs (target-dose, n=37,667) and 20,899 were initiated on ARBs (target-dose, n=4017) during 2000-2018. While remaining blinded to study outcomes, we assembled two propensity score-matched cohorts: ACEI (N=70,860; target-dose, n=35,430) and ARB (N=7900; target-dose, n=3950), balanced on 76 baseline characteristics. Hazard ratios (95% CIs) associated with target doses were estimated for 5-year KF and all-cause mortality, up to December 31, 2023. In the ACEI cohort, target-dose was associated with a 18% lower risk of KF (HR, 0.82; 95% CI, 0.75-0.89) and a 6% lower risk of death (HR, 0.94; 95% CI, 0.92-0.97). Subgroup and spline analyses showed that while the KF association was significant for those with baseline eGFR <35 ml/min/1.73m2, the mortality association was significant for those with eGFR ≥35 ml/min/1.73m2. In the ARB cohort, target-dose had no association with outcomes. In patients with HFrEF, target-dose (vs. below-target-dose) ACEIs, but not ARBs, were associated with lower risk of KF, which was significant in those with advanced CKD. The survival benefit was modest and limited to those without advanced CKD.

Angiotensin-converting enzyme inhibitors (ACEIs) have therapeutic value in various cardiovascular diseases and have protective effects on the heart, blood vessels, and kidneys; they are cornerstone drugs in the management of hypertension, heart failure, and chronic kidney disease. Despite the continual emergence of new drugs, ACEIs remain indispensable. The appropriate use of ACEIs helps reduce the risks of adverse cardiovascular events and mortality. In light of updates on the concept of interdisciplinary integration and the further accumulation of evidence from evidence-based medicine, the Chinese Society of Cardiology, the Editorial Board of the Chinese Journal of Cardiology, and the Hypertension Professional Committee of the Cross-Strait Medical and Health Exchange Association convened domestic experts in relevant fields to update the recommendations for applying ACEIs in cardiovascular diseases and to compile this consensus, with the aim of providing a reference for clinical physicians in China and improving the prevention and treatment of cardiovascular diseases.

Angiotensin Converting Enzyme (ACE) regulates blood pressure via the renin-angiotensin and bradykinin systems.Though synthetic ACE inhibitors are more effective, they pose several side effects.Methyl Palmitate (MP), a natural fatty acid methyl ester with cytoprotective, antioxidant, anti-inflammatory, and vasodilatory properties, is not explored for its ACE inhibitory or antihypertensive potential.This study aimed to investigate the in vitro ACE inhibition of MP and its effect on L-NG-Nitro Arginine Methyl Ester (L-NAME)-induced hypertensive male Wistar rats. An in vitro ACE inhibition assay was conducted to compare the ACE inhibition potency of MP with that of Lisinopril.Male Wistar rats (n = 35, 7 per group) were grouped into control, disease control, and treatment groups receiving 100, 150, or 200 mg/kg/day of MP for 21 days each.Blood pressure, serum ACE activity, malondialdehyde (MDA), and nitric oxide (NO) levels in kidney tissue homogenate, and thoracic aorta histopathology were assessed. MP inhibited ACE by 61.05% at 5 µM, exceeding Lisinopril's 41.67%. High-dose MP significantly reduced serum ACE and MDA levels, while increasing NO (p < 0.001).Histopathology revealed near-normal vasculature, although changes in blood pressure were not statistically significant (p > 0.05). MP demonstrates strong natural ACE inhibition, antioxidant, and vascular protective effects, supporting further research for therapeutic optimization.

Background: Arterial hypertension (AH) is a frequent comorbidity in patients with osteoarthritis (OA). Among antihypertensive agents, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), and beta-blockers (βBs) have been suggested to influence OA progression and symptomatology. The aim of this study was to assess whether the duration of effectiveness (DE) of viscosupplementation (VS) differs between patients with knee OA who are receiving antihypertensive treatment and those who are not. Methods: This post hoc analysis was conducted using data from a cross-sectional clinical trial (ClinicalTrials.gov Identifier: NCT04988698). The study included consecutive patients with knee OA who came for consultation at the Rheumatology Department and had received intra-articular hyaluronic acid injections within the past three years. The primary outcome was DE, self-reported by patients as the number of weeks of symptom relief. Associations between DE and various factors, including demographics, disease duration, radiographic OA severity (Kellgren-Lawrence grade and affected compartments), comorbidities, OA treatment history, antihypertensive therapy, physical activity level, and prior VS sessions, were analyzed using bivariate and multivariate models. Results: A total of 105 patients (65 women, 149 treated knees) were included. The mean age was 66.1 ± 13.2 years, and the mean body mass index (BMI) was 27.5 kg/m2. Thirty-eight percent of patients were receiving antihypertensive treatment (mean number of agents: 1.9; range: 1-4), including CCBs (n = 15), ACE inhibitors (n = 13), ARBs (n = 7), βBs (n = 6), and diuretics (n = 2). The overall mean DE of VS was 48.2 ± 24.8 weeks, with a trend toward longer DE in hypertensive patients compared to non-hypertensive patients (53.1 ± 31.3 vs. 45.4 ± 19.8 weeks, p = 0.06). Bivariate analysis identified significantly longer DE in patients with BMI < 27.5 kg/m2 (p = 0.002), Kellgren-Lawrence grade < 4 (p = 0.008), an active lifestyle (p = 0.005), unicompartmental OA (p = 0.01), medial tibiofemoral joint space narrowing (p = 0.046), and fewer than four prior VS sessions (p = 0.02). In multivariate analysis, AH was strongly associated with prolonged DE (p < 0.001), despite AH patients having a higher BMI (29.8 ± 5.5 vs. 25.2 ± 5.2 kg/m2, p = 0.001) and being more frequently sedentary (25.5% vs. 13.8%, p = 0.07). A trend toward longer DE was observed in patients treated with βBs and ARBs but not with CCBs or ACE inhibitors. Additional independent predictors of longer DE included BMI < 27.5 kg/m2 (p < 0.001), unicompartmental OA (p = 0.02), fewer than four prior VS sessions (p = 0.02), and an active lifestyle (p = 0.027). Conclusions: These findings suggest that antihypertensive treatment may extend the effectiveness of viscosupplementation in knee OA. However, the sample size was insufficient to determine whether specific classes of antihypertensive agents provide greater benefits. Further large-scale, prospective studies are warranted to clarify the potential impact of antihypertensive medications on viscosupplementation outcomes in knee OA.

Captopril, a thiol-containing angiotensin-converting enzyme (ACE) inhibitor, is known for its limited stability in biological matrices due to oxidative degradation. This study introduces a validated liquid chromatography–tandem mass spectrometry (LC–MS/MS) method for the quantification of captopril in human plasma, with stabilization achieved through the addition of sodium metabisulphite. Chromatographic separation was carried out using a Zorbax CN (Cyano) column measuring 75 × 4.6 mm with a particle size of 3.5 µm. The mobile phase consisted of methanol and 0.1% formic acid in a 70:30 (v/v) ratio. Detection utilized negative electrospray ionization mode, monitoring multiple reaction monitoring (MRM) transitions of 216.1 → 114.2 for captopril and 219.3 → 117.3 for the internal standard, Captopril D3. Sample preparation involved solid-phase extraction using MCX cartridges. The method was validated in accordance with ICH M10 guidelines. It demonstrated excellent linearity across the concentration range of 5.00 to 799.56 ng/mL, with high sensitivity, accuracy ranging from 99.14 to 101.69%, and precision with a coefficient of variation not exceeding 4.99%. The incorporation of sodium metabisulphite significantly enhanced the stability of captopril in plasma samples. This validated method is suitable for use in pharmacokinetic studies, bioequivalence assessments, and therapeutic drug monitoring.

This study aims to evaluate the efficacy of angiotensin-converting enzyme inhibitors (ACEi) in preventing anthracycline-induced cardiotoxicity in patients undergoing anthracycline-based chemotherapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing ACEi to standard treatment/placebo for cardiotoxicity prevention in patients undergoing anthracycline-based chemotherapy. We pooled outcomes of echocardiographic and cardiac biomarker changes. A random-effects model was used for all outcomes. We included 7 RCTs with 686 patients, of whom 346 (50%) received prophylaxis with ACEi. The most common malignancy was breast cancer, and the follow-up ranged from 6 to 31 months. Prophylactic use of ACEi was associated with a significantly smaller reduction in left ventricular ejection fraction (LVEF) compared to the control group (mean difference -5% [95% CI -8% - -2%]; p<0.010). Subgroup analysis limited to studies excluding trastuzumab from the chemotherapy regimens showed no significant difference (MD -7% [95% CI - 16% - 2%]; p=0.110). In contrast, in studies including trastuzumab-containing regimens, ACEi demonstrated a statistically significant effect in limiting LVEF reduction (MD -3%, [95% CI -4 - -1]; p<0.010). Diastolic function (E/A ratio) changes (MD 0.0 [95% CI -0.1 - 0.09]; I2=36.3%) and relative risk of increased troponin I at follow-up (RR 0.58 [95% CI 0.17 - 1.94]; I2=69.6%) were not statistically significant. Prophylactic ACEi administration in patients undergoing anthracycline-based chemotherapy was associated with a smaller decline in LVEF. This protective role may be more relevant in patients also receiving trastuzumab. More powered and longer follow-up studies are needed to confirm these findings.

Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers usage is associated with a reduced risk of seizures and epilepsy after ischemic stroke.

Modulation of blood pressure by estrogen: A modeling analysis.

Open-label Randomized Controlled Trial of Controlled-release Formulation Budesonide in Indian Proteinuric IgA Nephropathy Patients.

BRASH syndrome is defined as a clinical condition in which bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia interact to form a self-perpetuating negative spiral. Geriatric practitioners are increasingly likely to encounter elderly patients with this syndrome who are taking AV nodal blocking agents, such as calcium channel blockers (CCBs) or β-blockers. However, it remains unclear how the heart failure (HF) pandemic and coronavirus disease 2019 (COVID-19) have influenced the incidence, triggers, management, and clinical course of BRASH syndrome. Therefore, open-access databases were searched for publications from 1980 to 2025, identifying 41 eligible articles reporting a total of 54 patients with BRASH syndrome. The mean age of affected patients was 69.0 ± 15.1 years. Hypertension (HTN, 74%), chronic kidney disease (CKD, 61%), and diabetes (54%) were the most common comorbidities. More than half of the patients (52%) were prescribed angiotensin-suppressing agents (angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor-neprilysin inhibitors (ARNI)) for HTN or HF. Two elderly patients were diagnosed with BRASH syndrome triggered by COVID-19. This literature review clarifies that BRASH syndrome commonly occurs in elderly patients with HTN or CKD and is often associated with everyday clinical events such as anorexia, vomiting, diarrhea, bleeding, and infection, including COVID-19. Our database search supports recognizing BRASH syndrome as an important clinical entity in geriatric emergency medicine. Geriatric practitioners should be aware of this condition to enable early diagnosis and appropriate management in the modern HF and post-COVID-19 era.

Advances in Cardiovascular Pharmacotherapy. VI. Sacubitril-Valsartan, An Angiotensin Receptor-Neprilysin Inhibitor.

Objective : Acute kidney injury (AKI) is a common and serious complication in traumatic intracranial hemorrhage (tICH), leading to worse outcomes. Blood pressure variability (BPV), beyond mean blood pressure levels, may impair end-organ perfusion and predispose to AKI. However, the relationship between BPV and AKI in tICH patients remains poorly defined. We investigated the association between BPV and AKI in patients with tICH.Methods : We conducted a retrospective cohort study of tICH patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Inclusion required ≥24 systolic and diastolic blood pressure measurements within the first 24 hours of intensive care unit admission. BPV indices, average real variability (ARV), standard deviation (SD), and coefficient of variation (CV), were calculated for both systolic (SBP) and diastolic pressures. Univariate and multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for AKI. Two adjustment schemes were applied : group 1 (age, congestive heart failure, diabetes) and group 2 (group 1 covariates + vasoactive agents, mannitol, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, hypertonic saline). Analyses were performed in the hypertensive subgroup (mean SBP ≥140 mmHg), using the same covariate adjustment schemes.Results : Among 551 patients, AKI developed in 385 (69.9%). In multivariate analysis with adjusted for all confounders, higher SBP_ARV (OR, 1.046; 95% CI, 1.004–1.095; p=0.048) and SBP_SD (OR, 1.052; 95% CI, 1.010–1.099; p=0.018) were independent predictors of AKI. In hypertensive subgroups, after adjustment for all confounders, associations were even stronger : SBP_ARV (OR, 1.285; 95% CI, 1.064–1.553; p=0.009), SBP_SD (OR, 1.203; 95% CI, 1.022–1.417; p=0.027) and SBP_CV (OR, 1.273; 95% CI, 1.012–1.601; p=0.039).Conclusion : Elevated systolic BPV independently predicts AKI in tICH patients. Incorporating BPV monitoring into neurocritical care protocols may help identify high-risk patients and guide interventions to stabilize blood pressure fluctuations, potentially minimizing AKI risk.

Identification and validation of quinoa-derived ACE inhibitory peptides via multidimensional molecular descriptor clustering.

Hypothesis/Introduction The renin-angiotensin system plays a central role in renal ischemia-reperfusion injury (IRI). We evaluated the effects of angiotensin-converting enzyme inhibitors (ACEIs) and AT1 receptor blockers (ARBs) in preclinical renal IRI models using multilevel and network meta-analyses (PROSPERO: CRD42024599859). Materials and Methods Database searches identified 55 studies. Serum creatinine data were pooled using three-level random-effects models (96 comparisons, n = 1233 animals). Publication bias was assessed using Egger and 1/√n methods. Drugs were ranked via P-scores. Results ACEIs/ARBs significantly reduced creatinine (standardized mean difference: −1.74; 95% CI: −2.22 to −1.26; p &lt; 0.0001) with high heterogeneity. Egger's test showed asymmetry ( p &lt; 0.0001), but 1/√n-based testing did not ( p = 0.160), suggesting mathematical artifact rather than publication bias. Multivariable meta-regression identified drug identity, dose, and route as key effect modifiers. Network analysis ranked azilsartan and telmisartan highest, though evidence remains limited (no direct comparisons, n = 2 for azilsartan). Secondary outcomes confirmed renal protection. Conclusions ACEIs/ARBs effectively reduce renal IRI in animals, with azilsartan and telmisartan ranking favorably despite limited evidence. High-dose intravenous administration enhances efficacy. Most studies used pre-ischemia protocols relevant only to transplantation. Post-injury models with comorbid animals of both sexes and direct drug comparisons are needed for clinical translation.

Among the various risks of cardiovascular disease, hypertension and hypercholesterolemia are the greatest risks. Renin-angiotensin-aldosterone system inhibitor medication, consisting of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, as well as statins, is used to treat hypertension and hypercholesterolemia, respectively. The effect of this medication on inflammatory reactions has been demonstrated by various studies, as well as its effect on periodontal tissue. This study aims to determine the effect of renin-angiotensin-aldosterone system inhibitor medication and statins on the periodontal status of patients at risk of cardiovascular disease. Search for studies through electronic databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Studies that met the inclusion criteria are included and assessed for risk of bias and then meta-analysed. Qualitative synthesis showed inconsistent results regarding the effect of RAAS inhibitors on periodontal status. Meta-analysis between the statin group compared with other interventions such as diet found that the mean bleeding on probing index found a statistically significant difference with a mean difference of -13.4% (95% CI:[-23.08;-3.72], p = 0.007), the mean clinical attachment loss did not show any significant difference with a mean difference of -0.16mm (95% CI: [-0.40;-0.07], p = 0.17), and mean probing depth there was a statistically significant difference between groups with a mean difference of -0.38mm (95% CI:[-0.53;-0.23], p < 0.00001). The effect of renin-angiotensin-aldosterone system inhibitor medication in the form of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in hypertensive patients on periodontal status showed inconsistent results and statin medication systemically could improve periodontal status, bleeding on probing index, and probing depth in patients with hypercholesterolemia.

It is still unclear whether hypertensive patients using angiotensin II receptor blockers (ARBs) have a different risk of developing dementia compared with those taking angiotensin-converting enzyme inhibitors (ACEIs). We conducted a prospective cohort study using the 45 and Up Study Cohort in patients aged ≥ 45years with hypertension who initiated ARB or ACEI therapy between 2004 and June 30, 2022. ARB/ACEI exposure was defined as having a supply that covered at least 80% of their follow-up period. Propensity score matching was used to balance baseline characteristics. We used the Cox proportional hazards model to estimate the risk of incident dementia. We included 51,574 patients with hypertension (mean age 66.3 (9.0) years; 48.2% women), with a mean follow-up of 11.3 (5.2) years. After controlling for major modifiable lifestyle factors such as diet and physical activity, ARB use was linked to a significantly reduced risk of dementia compared with ACEI use (hazard ratio [HR] = 0.72; 95% confidence interval [CI]: 0.65-0.80, p < 0.001). In exploratory agent-level analyses, compared with lisinopril, olmesartan (HR = 0.32; 95% CI: 0.16-0.62), candesartan (HR = 0.41; 95% CI: 0.24-0.69), telmisartan (HR = 0.42; 95% CI: 0.25-0.71), irbesartan (HR = 0.45; 95% CI: 0.27-0.75), and perindopril (HR = 0.52; 95% CI: 0.31-0.87) were associated with a significantly lower risk of dementia, while captopril showed a significantly increased risk (HR = 4.9; 95% CI: 1.04-23.4). The findings were consistent across subgroup analyses (sex, head-to-head ARBs vs ACEIs) and sensitivity analyses (excluding hypertension defined only by antihypertensive medication use, adjusting for competing risk of death or inverse probability of treatment weighting analysis). Among hypertensive patients, ARB use was linked to a reduced risk of dementia compared with ACEI treatment, regardless of diet and physical activity, and the effect varied across specific agents. These findings highlight the potential role of ARBs in dementia prevention; however, further randomised controlled trials are needed to confirm them.

Proteinuria and hematuria are both significant predictors of impaired kidney function in IgA nephropathy (IgAN). We evaluated the efficacy and safety of ambrisentan, a selective endothelin A receptor antagonist, as adjunctive therapy in a real-world cohort of high-risk IgAN patients. In this retrospective, single-center study, we analyzed 169 patients with biopsy-proven IgAN who received adjunctive ambrisentan for ≥6 months. A propensity score-matched historical control group (138 pairs) was generated from patients receiving standard care prior to the ambrisentan era. Laboratory test results were gathered at baseline, and at 3 and 6 months. A generalized estimating equation model was employed to adjust for potential confounders. In the full ambrisentan cohort (n = 169), median urinary protein-to-creatinine ratio (UPCR) decreased significantly by 58.4% (95% confidence interval [CI], 49.8-62.3) at 6 months, with 75.7% of patients achieving a ≥30% reduction. Hematuria was also significantly reduced (P < .001), and kidney function remained stable. Compared to the matched controls, the ambrisentan group (n = 138 after propensity score-matching) demonstrated a greater median relative reduction in UPCR (-59.7% vs. -53.7%; P = .015). However, a decrease in hemoglobin levels was observed, with an increased incidence of anemia. The proteinuria-lowering effect was enhanced in patients concurrently receiving angiotensin converting enzyme inhibitors (ACEi)/ angiotensin receptor blockers (ARBs) or finerenone. In this analysis incorporating a matched historical control, adjunctive ambrisentan significantly reduced proteinuria and hematuria in patients with IgAN without affecting kidney function. The proteinuria-lowering effect was more pronounced when ambrisentan was added to an ACEi/ARB or finerenone. Notably, a significant decline in hemoglobin levels was observed, indicating a need for monitoring. These results warrant further prospective trials to confirm the long-term renal benefits and safety of ambrisentan in IgAN.