ACE inhibors

[Comebacktome]

nursing student here with the goal of getting into med school someday. Qq how does ace inhibitors cause altered renal function, I see no connection and read an article on ncbi but still dont get it.
They increase filtration rate and actually helps the body so I dont really see the patho behind that. TIA
Sorry if i posted it in the wrong place new on here and dont really know what im doing. Pls dont scold me lol

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[ashtray81]

If you have normal kidney function, then taking them is okay since the kidney is still receiving enough perfusion to do the things it needs to do

But say you have renal stenosis or chf which doesn't allow enough blood perfusion, then it will make the kidneys worse since a ace-i constrict THE EFFERENT arteriole that supplies the kidney with blood
Basically ace-i make the highway to the kidney smaller which is very bad when the highway already has two lanes closed

 

[Comebacktome]

If you have normal kidney function, then taking them is okay since the kidney is still receiving enough perfusion to do the things it needs to do

But say you have renal stenosis or chf which doesn't allow enough blood perfusion, then it will make the kidneys worse since a ace-i constrict THE EFFERENT arteriole that supplies the kidney with blood
Basically ace-i make the highway to the kidney smaller which is very bad when the highway already has two lanes closed

thank you that makes perfect sense. In other words can cause "renal hypertension" right?

 

[ashtray81]

you got it.

 

[manduki]

If you have normal kidney function, then taking them is okay since the kidney is still receiving enough perfusion to do the things it needs to do

But say you have renal stenosis or chf which doesn't allow enough blood perfusion, then it will make the kidneys worse since a ace-i constrict THE EFFERENT arteriole that supplies the kidney with blood
Basically ace-i make the highway to the kidney smaller which is very bad when the highway already has two lanes closed

This is my understanding of ACE-i's on AKI.

Angiotensin II is a vasoconstrictor. Its effect is greater on the efferent arteriole than on the afferent arteriole, thereby maintaining glomerular filtration pressure in patients with poor renal perfusion (as you mentioned chf or renovascular disease).

ACE inhibitors lower the level of angiotensin II. In essential hypertension, glomeruli are not dependent on efferent arteriolar vasoconstriction and receive adequate perfusion, which is why ACE-i's work well in this patient group. In the chf or renovascular group whose glomerular perfusion is dependent on angiotensin II, this leads to relative vasodilation of the efferent arteriole, leading to decreased glomerular pressure and AKI.