Angiotensin-converting enzyme inhibitors renal insufficiency

ACE-I, angiotensin-converting enzyme inhibitors ARB, angiotensin-receptor blockers AZA, azathioprine CMV, cytomegalovirus CPK, creatinine phos-phokinase CSA, cyclosporine HMG-CoA, 3-hydroxy 3-methylglutaryl coenzyme A reductase K+, potassium LFTs, liver function tests Rl, renal insufficiency SCr, serum creatinine SRL, sirolimus TAC, tacrolimus TMP-SMX, trimethoprim-sulfamethoxazole. 

NSAIDs should be avoided in patients with chronic renal insufficiency due to the risk of inducing further kidney damage. In patients at risk, acute renal feilure can occur after a single dose of drug. Risk fectors include dehydration, hypertension, congestive heart failure, concomitant use of angiotensin-converting enzyme inhibitors, and advanced age. 

Metolazone occupies an intermediate position between the thiazide diuretics and the more potent loop diuretics (1). It is more effective than the thiazides in moderate to advanced renal insufficiency (SED-8, 488) (SED-9, 355). In patients with normal renal function its antihypertensive effect compares favorably with that of bendroflumethia-zide. When severe heart failure is refractory to conventional triple therapy (high-dose loop diuretic, digoxin, and angiotensin-converting enzyme inhibitor) metolazone can restore diuresis, with weight loss and clinical improvement. 

Angiotensin-converting enzyme inhibitors can cause renal insufficiency in patients with bilateral renal artery stenosis or stenosis of the artery supplying a single functioning kidney. Concomitant diuretic treatment may play a role in this adverse reaction (38). 

Murphy BF, Whitworth JA, Kincaid-Smith P. Renal insufficiency with combinations of angiotensin converting enzyme inhibitors and diuretics. Brit Med J 1984 288 844-845. 

Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, Ponticelli C, Ritz E, Zucchelli P. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 1996 334 939-945. 

Toto Mitchell HC, Lee H-C, Milam C, Pettinger WA. Reversible renal insufficiency due to angiotensin converting enzym e inhibitors in h3 ertensive nephrosclerosis. Ann Intern Med... 

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