ACE and chronic kidney disease: Frequently, IgAN patients present at diagnosis with moderately advanced CKD, that is, CKD stage 3 and 4, after a silent but slowly progressive course and ESKD occurs in up to 50 percent of the patients after 20 to 25 years.[21] In these patients, angiotensin II inhibition with an ACE-inhibitor or angiotensin receptor blocker slows the rate of progression of most proteinuric CKD, an effect that is mediated at least in part by lowering both the systemic blood pressure and the intraglomerular pressure, thereby reducing both proteinuria and secondary glomerular injury.[21,22,25]