Diuretics potentiate ACEI's Nephrotoxicity?

[monstersaurous]

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Hi all, Im stumped once again.

How do diuretics (loop and thiazides) potentiate ACEI's nephrotoxicity?

My guess is that diuretics cause hypovolemia, leading to reduced glomerular filtration, which adds on to that caused by ACEIs (due to dilation of the efferent glomerular arteriole).

But im quite sure there's more to the equation than this.

Would appreciate any help from you guys! Cheers!

 

[Requiem]

Hi all, Im stumped once again.

How do diuretics (loop and thiazides) potentiate ACEI's nephrotoxicity?

My guess is that diuretics cause hypovolemia, leading to reduced glomerular filtration, which adds on to that caused by ACEIs (due to dilation of the efferent glomerular arteriole).

But im quite sure there's more to the equation than this.

Would appreciate any help from you guys! Cheers!

your understanding is the same as mine;

when initiating an ace i recommend holding the diuretics for a couple of days to ensure euvolemia. The problem with increased SCr is only for the first week or so, so that's the critical period.

Angiotensin constricts both the afferent and efferent arterioles to my knowledge; but the effect is more profound on the efferent (prostaglandins mediate the afferent)

cheers