Interest in this approach has been increased by the evidence that individuals treated with ACE-Is may have aldosterone breakthrough 89 with angiotensin I to angiotensin II conversion occurring via other and by the fact that there may be other active receptors for angiotensin II422 that may have a range of roles. A number of moderate-sized studies, mostly in patients with diabetes, have demonstrated that proteinuria levels may be further lowered by combining ACE-Is and ARBs than by using each agent alone.423 Aldosterone antagonists may substantially lower proteinuria when used on top of ACE-Is Similarly when the DRI, aliskiren, was added to proteinuria was reduced. The optimism generated by these findings has recently been seriously dampened. 