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Old 02-09-2013
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Kidney ACEI effects on Kidney Function?

I can't understand how ACEI can protect the kidney and in the same time may harm it!
Please anyone explain it?

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ACEI can protect the kidney only under specific condition and may harm it in certain conditions depending on the etiology.

For example, in Diabetes there is glomerular hypertension. ACE-I protect the kidney by reducing glomerular hypertension through efferent arteriolar dilation. They do cause decrease in GFR (raises BUN & Creatinine) in the short term but their beneficial effect on the kidney by reducing glomerular hypertension more than compensates for the reduced GFR in the long term.

In BILATERAL renal artery stenosis they harm the kidneys by causing decrease in renal perfusion as the body cannot compensate by increasing the renal perfusion.
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Quote:
Originally Posted by Novobiocin View Post
ACEI can protect the kidney only under specific condition and may harm it in certain conditions depending on the etiology.

For example, in Diabetes there is glomerular hypertension. ACE-I protect the kidney by reducing glomerular hypertension through efferent arteriolar dilation. They do cause decrease in GFR (raises BUN & Creatinine) in the short term but their beneficial effect on the kidney by reducing glomerular hypertension more than compensates for the reduced GFR in the long term.

In BILATERAL renal artery stenosis they harm the kidneys by causing decrease in renal perfusion as the body cannot compensate by increasing the renal perfusion.
Thanks for reply

1- So , it is protect the kidneys only in Diabetes ?
I was thinking it is also protect the kidneys in lupus pt, is n't it ?

2- What 're the causes that may harm the kidneys beside RAS ?
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3- Do we screening for BUN & Creatinine after short period of ACEI ? if yes, why do we do this if we already know it is cause decrease in GFR and raises BUN & Creatinine ?

appreciate your reply
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Originally Posted by swwal View Post
3- Do we screen for BUN & Creatinine after short period of ACEI ? if yes, why do we do this if we already know it is cause decrease in GFR and raises BUN & Creatinine ?

appreciate your reply
Because you would stop ACEI if the renal functions are deteriorating progressively. You can't let patient have ESRF due to ACEI.
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Quote:
Originally Posted by swwal View Post
Thanks for reply

1- So , it is protect the kidneys only in Diabetes ?
I was thinking it is also protect the kidneys in lupus pt, is n't it ?

2- What 're the causes that may harm the kidneys beside RAS ?
It has many uses apart from diabetes.
ACEI are not used for Lupus nephritis. However, it is used to prevent renal crisis in systemic sclerosis.
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Originally Posted by Novobiocin View Post
It has many uses apart from diabetes.
ACEI are not used for Lupus nephritis. However, it is used to prevent renal crisis in systemic sclerosis.
I mean in Lupus nephritis , when pt has PROTEINURIA it is good to give ACEI..
http://jasn.asnjournals.org/content/21/12/2028.full

"The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines recommend interruption of the RAAS with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers as first-line anti-hypertensive therapy in the management of proteinuric kidney diseases, including lupus nephritis."
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