What's the role of ACE inhibitors in Renal Artery Stenosis? - USMLE Forums
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Old 05-01-2011
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Drug What's the role of ACE inhibitors in Renal Artery Stenosis?

its given in FA pg 474 i dnt get this abt ACE inhibitors n bil. renal artey stenosis?
i knw by ACE inhi. Ag ll is inhibited. n so efferent arteriole constriction inhibited which decreases GFR so in bil. artery stenosis the GFR must b low cos renal artery will form afferent arteriole ultimaltely n its constriction decreases GFR so is the drug contraindicated in this condition??????
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Old 05-01-2011
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Seems like you are close to figuring it out, but here is what I think/know:

When the kidney is not getting enough blood flow, as in renal artery stenosis, JG cells secrete Renin in response to the decreased pressure in the glomeruli. Renin will lead to increased Angiotensin II, which preferentially constricts the efferent arteriole to increase GFR to compensate for the decreased blood flow. If ACE inhibitors are given, the efferent arterioles cannot constrict so there may be an unsafe drop in GFR, which can lead to renal failure. (in unilateral disease the opposite kidney compensates)
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Old 05-01-2011
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Good explanation by apx85! This was also discussed in this thread..
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Old 05-02-2011
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On a question stem - and in real life - the patient will present with hypertension refractory to treatment >1 class of antihypertensive meds.
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Pathology-, Pharmacology-, Physiology-, Renal-

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