spv
Forum Newbie
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HI
If ace inb r contraindicated in renal artey stenosis. what is teh drug of choice for these patient to reduce bp? Thanks.
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| po
Forum Elite
Topics: 39
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Medication is used to control hypertension (high blood pressure). Blood pressure medications that directly affect the renin angiotensin pathway can be used toe help control blood pressure. ACE inhibitors and angiotensin receptor blockers (ARBs) are often very effective in patients with unilateral RAS. In some cases, patients with RAS are resistant to these medications.
In patients with bilateral RAS, these medications must be used carefully, because they may cause acute renal failure (ARF). If acute renal failure develops (i.e. creatinine increases by more than 30%), the medication is discontinued and the patient is evaluated for bilateral RAS.
Angioplasty and stenting may be used to improve blood flow. The goal is to improve the circulation of blood flow to the kidney and prevent the release of excess renin, which can help to decrease blood pressure. This helps to prevent atrophy of the kidney. In general, patients with AS-RAS should have stenting done because plasty by itself has a very high incidence of re-stenosis.
Surgery to bypass the narrowing may be performed. If the kidney with RAS has atrophied, a nephrectomy, surgical removal of the kidney, may be advised.
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| po
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Clinicians must rely on pharmacologic agents (eg, combination of calcium channels blockers to control blood pressure and optimize renal perfusion), accepting the high probability of deterioration in renal function and shortened survival.
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| po
Forum Elite
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Drugs to be avoided in patient with renal artery stenosis
Some medications can reduce kidney blood flow. This can lead to trouble if the blood supply is already reduced by renal artery stenosis, as kidney function can be severely reduced. The major medications that can cause this problem are:
* Non Steroid Anti Inflammatory Drugs (NSAIDs)
* Angiotension Converting Enzyme Inhibitors (ACE Inhibitors; usually there must be narrowing of arteries to both kidneys to have this effect)
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| Ancylostoma
Forum Guru
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I dont want to be contradicting , however I have read that new evidence points to caution when using ace inhibitors in the presence of renal artey schlerosis. The new harrisons says that the treatment of choice in the presence of any renal stenosis is a thiazide diuretic. Thiazide and betablockers are the first line hypertensives. This fact doesnt change. if your talking about the nmbe questions , go with thiazide.
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| po
Forum Elite
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hi ancylostoma,
u r right,even I had same thing in mind....but it was from some nephrology site;
http://www.nephrologychannel.com/ras/index.shtml
unilateral rs...one can still be given this ACE??Acc to the site??
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| Ancylostoma
Forum Guru
Topics: 42
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you can still be given ace inhibitors in the presence of unilateral stenosis, however, since thiazides re first line hypertensives, and the treatment of choice of renal artery stenosis, you must go with them. I just wanted to clairify. I had to myself look through harrisons because I wanted to know the definative answer.
Edited by Ancylostoma on 12/28/06 - 05:45 PM
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