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ACE inhibitors Nephrotoxic or Nephroprotective

21255 Views 17 Replies 11 Participants Last post by  soni1075
In Goljan it is given,

that ACE inhibitors are beneficial in diabetic nephropathy cause they maintain renal perfusion beyond efferent arteriole and thereby supplying blood to kidney parenchyma.

but in UW its given ACE mediated nephrotoxity is due to :


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In case of renal artery sclerosis we have only one regulatory mechanism - ATII constrict the efferent arteriole (see FA, p.458). In the other words "we" can't dilate afferent arteriole (because it sclerotic). So we can increase GFR/perfussion ONLY by constricting efferent arteriole by Angiotensin II.
If we will use ACE inhibitors we just block to conversion of AT to ATII and we will have lost control to renal perfusion.

Actually in some causes (may be in most) renal artery sclerosis is not well recognised. :(
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