ACE Inhibitors and ARBs
Reviewed by: HU Medical Review Board | Last reviewed: June 2026 | Last updated: June 2026
ACE inhibitors and ARBs are blood pressure medicines that have long been the foundation of IgA nephropathy treatment.
Most people with IgA nephropathy start on one of these, often before any newer drug is added. They help in 2 important ways: they lower blood pressure, and they reduce the amount of protein leaking into your urine.1-4
What are ACE inhibitors and ARBs?
These are 2 related groups of medicines that you take by mouth:1
- ACE inhibitors – ACE stands for angiotensin-converting enzyme. (Many generic names end in “-pril.”)
- ARBs – ARB stands for angiotensin receptor blocker. (Many generic names end in “-sartan.”)
Both act on the same body system, called the renin-angiotensin system, which helps control blood pressure. Your doctor will usually prescribe one or the other, not both together.1
How do they help in IgA nephropathy?
In IgA nephropathy, lowering blood pressure protects the kidneys from further damage. These medicines also lower the pressure inside the kidney’s tiny filters, which reduces how much protein leaks into the urine. Lowering urine protein is one of the main goals of treatment, because it is linked to slowing the progression of the disease.1,3,4
Even if your blood pressure is not high, your doctor may prescribe 1 of these medicines for their kidney-protecting effect.1
What are the possible side effects?
Side effects can vary depending on the specific drug you are taking. Your doctor will monitor you with blood and urine tests after you start or change a dose. You may experience a cough, dizziness, high potassium levels, or fatigue. In rare cases, you might get sudden swelling of the face, lips, tongue, eyelids, hands, feet, and genitals. Tell your doctor about any new symptoms you may have.
Talk to your doctor about what to expect when taking these medicines. You also should call your doctor if you have any changes that concern you while taking them.
How do they fit with other treatments?
ACE inhibitors and ARBs are the base layer of IgA nephropathy care. Newer medicines, such as SGLT2 inhibitors and drugs approved specifically for IgA nephropathy, are often added because they protect the kidneys in different ways.4
Other things to know
ACE inhibitors and ARBs are FDA-approved to treat high blood pressure, and some are approved to protect the kidneys in people with type 2 diabetes. They are not FDA-approved specifically to treat IgA nephropathy. A doctor may prescribe a medicine “off-label” – meaning for a use other than its FDA-approved one – when evidence suggests it helps. Their long, established role in kidney care is why they remain a cornerstone of treatment. Talk to your doctor about what is right for you.
Before beginning treatment for IgA nephropathy, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.
Talk to your doctor
Your doctor can explain which medicine is the best fit for you, how it works with your other treatments, and what to watch for. Do not stop or change your dose without talking to your care team first.