ACE-Inhibitors and renal function

[shroomysoup]

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I never understood this. ACE-Inhibitors help patients with chronic kidney disease by preventing its progression, but why does it increase serum creatinine? Wouldn't that increase the progression of CKD? Also, why is it contraindicated in renal artery stenosis if it is beneficial in the prevention of CKD?

 

[njac]

I'll answer this when I get back from dinner if no one else has.

but I just wanted to say my dog is on benazepril for her kidney dz.

 

[Requiem]

ACE-I, ARBs and NON-DHP CCB are renoprotective, independent of their BP lowering effects.

ACE inhibitors decrease intraglomerular pressure via inhibiting production of angiotensin II, which is an efferent arteriole vasoconstrictor. This decrease in pressure leads to a decrease in proteinuria, which is what makes it renoprotective,

ACE-I's can initially cause an acute renal failure, and you don't stop therapy unless SCr is >30% from baseline. As above, once you decrease the intraglomerular pressure, you will decrease filtration hence increasing SCr.

In bilateral renal artery stenosis, kidneys are already hypoperfused (increased risk for ARF) and ACE-I's may/will worsen this.

 

[rxforlife2004]

ACE-I, ARBs and NON-DHP CCB are renoprotective, independent of their BP lowering effects.

ACE inhibitors decrease intraglomerular pressure via inhibiting production of angiotensin II, which is an efferent arteriole vasoconstrictor. This decrease in pressure leads to a decrease in proteinuria, which is what makes it renoprotective,

ACE-I's can initially cause an acute renal failure, and you don't stop therapy unless SCr is >30% from baseline. As above, once you decrease the intraglomerular pressure, you will decrease filtration hence increasing SCr.

In bilateral renal artery stenosis, kidneys are already hypoperfused (increased risk for ARF) and ACE-I's may/will worsen this.

right on..