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Old 09-27-2012
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Question ACEI in Renal Artery Stenosis?

I always thought ACEI were contraindicated in Renal Artery Stenosis but Kaplan IM book says the following statement: "Medical therapy with ACEI should be reserved only for those in whom angioplasty or surgery either fails or is not possible"

So if this is the case then are we allowed to give ACEI to patients with RAS?
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Old 09-27-2012
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It depends whether it is b/l or unilateral stenosis. for b/l- angioplasty is the best and for uni either angioplasty or ACEI (none of them are superior to one another).
I hope this clarifies.
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Old 09-27-2012
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Best thing ever is surgery, however, bilateral renal artery stenosis is only treated with a surgical approach.

If you give ACEi's in bilateral renal stenosis, you will further compromise the already poor blood flow to the kidneys, causing acute renal failure, thats why they are not given in BILATERAL kidney disease.
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