Renal artery stenosis question

[Kobebucsfan]

52-year-old man is found to have hypertension during a routine examination A systolic bruit is heard over the left renal artery Angiography shows a discrete 95% obstructive lesion within the left renal artery; the right renal artery is normal The right kidney is 11 ern, and the left kidney is 8.5 cm Which of the following describes the most likely response to treatment?

A) Decreased plasma renin activity and decreased serum angiotensin I concentration following administration of a loop diuretic

B) Decreased plasma renin activity following administration of an angiotensin-converting enzyme inhibitor (ACEI)

C) Increased plasma renin activity and decreased serum angiotensin I concentrations following administration of a loop diuretic

D) Increased plasma renin activity following administration of an ACEI


i'm thinking choice D, because if you give an ACEI - u get less Ang II and less Aldosterone. so renin will increase to make more Ang II and Aldosterone. is my reasoning correct ?

Also why cant u give someone ACEI if they have bilateral renal stenosis. if they have bilateral stenosis, kidneys will secrete so much renin --> AngII --> Aldosterone and wouldnt u get lot of fluid overload ?

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[Transposony]

Yes. Left kidney is already secreting more Renin ( hence HT) due to RAS and on top of that if you block AT 2 then the normal kidney also starts making Renin.

In B/L RAS the GFR is being maintained by AT2 sitting on efferent arteriole and if you block AT2 the GFR will drop precipitously leading to renal failure.