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Renal damage and ACE inhibitor use in renal artery stenosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The glomerular filtration pressure is determined by three main variables:

  • systemic blood pressure
  • vasomotor tone in the afferent arteriole
  • vasomotor tone in the efferent arteriole

In cases of bilateral renal artery stenosis (or unilateral stenosis if there is only one functional kidney):

  • the glomerular filtration pressure is dependent on the vasoconstriction of the efferent arteriole because the resistance of the afferent blood vessels has been pathologically increased
    • vasoconstriction of the efferent arteriole is mediated by angiotensin II
    • administration of an ACE inhibitor abolishes the vasoconstriction of the efferent arteriole resulting in an abrupt fall in the glomerular filtration rate
    • the deterioration in renal function due to ACE inhibitors is usually reversible on stopping the drug

The EMC states that a contraindication to use of an ACE inhibitor is

  • significant bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney (1)


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