Ace inhibitors c/i renal artery stenosis (b/l)

Ace inhibitors c/i renal artery stenosis (b/l)

Angiotensin-converting enzyme (ACE) inhibitors are contraindicated in patients with bilateral renal artery stenosis.

Renal artery stenosis (RAS) is a condition characterized by narrowing of the arteries that supply blood to the kidneys. Bilateral renal artery stenosis refers to the narrowing of both renal arteries. In this condition, the kidneys receive reduced blood flow, leading to decreased renal perfusion.

ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thus leading to vasodilation of blood vessels. However, in the context of bilateral renal artery stenosis, ACE inhibitors can further decrease renal perfusion pressure, exacerbating renal insufficiency and potentially leading to acute kidney injury (AKI). This occurs because ACE inhibitors can cause efferent arteriolar dilation, which decreases intraglomerular pressure. In individuals with already compromised renal blood flow due to bilateral renal artery stenosis, this further reduction in pressure can lead to renal ischemia and worsening kidney function.

Therefore, ACE inhibitors are contraindicated in patients with bilateral renal artery stenosis due to the risk of precipitating AKI and worsening renal function. Instead, alternative medications such as angiotensin II receptor blockers (ARBs) or direct renin inhibitors may be considered for blood pressure control in these patients.