NPPA and chronic kidney disease: Chronic kidney disease is associated with an imbalance of vasoactive substances in the kidney, with an increase in vasoconstrictor agents, such as Ang II and endothelin-1, and a reduction in vasodilator agents, such as nitric oxide, bradykinin, and ANP, which causes renal hemodynamics alterations and intraglomerular capillary hypertension (Benigni et al., 2004).