Thread: ace inhibitors and renal disease

are ace i are safe in the renal diseases

as to my knowledge ACE inhibitors slow the progression of nephropathy,associated with DM or persistent HTN. they should b safe. however, they might cause proteinuria and progression of renal failure in renal insufficient patients

till what level of creatinine we can use ace

there is some vague guideline of 3.5 mg/dl.. but even with high createnine in CRF u can continue ACE Inb.. cos after some time the creatinine is not going to matter! It wil stabilize, and ACE Inb wil hav its reno protective effect!

nice question..
1 mark question related to this topic was asked in our university exam last year..
well if renal failure has progressed then they shouldn't be used.
otherwise safe.

rightnow not gettin excat mechanism but it was like that angiotensin can't act on main site and action on minor site become prominent so inhibition of it's effect will result in opposite then expected.
[check Goodman and Gilman & KDT doe further info.]

yeh when u see pt there are several points swhere u have to take a decision making on this point i have here quoting some work about this hope so u guys enjoy this especially those who really face such challenges in their patients

For patients with mild-to-moderate renal insufficiency (serum creatinine level, 3.0 mg/dL or less), ACE inhibitors provide known renal protective effects; however, for patients with advanced renal insufficiency (serum creatinine levels of approximately 3.0 - 5.0 mg/dL), the effects of ACE inhibitors are poorly defined.
The use of ACE inhibitors, particularly benazepril, resulted in substantial renal benefits in nondiabetic patients with advanced renal insufficiency.



reference Medscape Medical News 2006. © 2006 Medscape

Data from these studies in patients with diabetic and nondiabetic renal disease demonstrated that if an elevation in the serum creatinine level does occur, it stabilizes quickly and does not progressively worsen. In addition, this reduction in GFR is reversible. The authors conclude that no one should be denied a long-term trial of an ACE inhibitor because of a preexisting elevation of serum creatinine level or one that increases up to 30 percent from baseline and then stabilizes within two to three weeks. If elevations in serum creatinine of more than 30 percent occur on a chronic basis within the first month or if hyperkalemia occurs, the drug should be withdrawn
refernce BARBARA APGAR

ACE inhobitours should be avoided in advanced renal failure, bilateral renal artery stenosis.
Why?

as to renal artery stenosis, its the rise in blood pressure secondary to activation of renin-angiotension that maintains optimal GFR. so if we inhibit that axis by use of ACE inhibitor then we r going to worsen the renal fuction

Rabia ur right. Also ACEI itself increase the renin levels which worsen the condition further.