ACE-I in renal artery stenosis

 Q: Angiotensin-converting enzyme inhibitors (ACE-I) should not be given to all of the following patients EXCEPT? (select one) 

A) previous lip swelling

B) previous unexpected drop in blood pressure 

C) known unilateral renal artery stenosis 

D) previous Acute Kidney failure from ACE-I 

  * previous is equivalent with use of ACE-I

 Answer: C

The objective of this question is to clarify the point that ACE-I is contraindicated in only bilateral renal artery stenosis. Actually, it is beneficial in unilateral renal artery stenosis. 

Another myth to avoid is ACE-I in any level of kidney dysfunction, which is not true. Patients who are candidates for its use due to left ventricular dysfunction can be prescribed for its mortality benefit up to serum creatinine above 3 mg/dL. Also, it can be used in patients who are already on dialysis.

#nephrology

#pharmacology

References:

1. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from AAVS/SVS, CAI, SVMB, SIR, and the ACC/AHA Task Force on Practice Guidelines: endorsed by the AACPR, NHLBI, SVN, TISC, and VDF. Circulation 2006; 113:e463. 

2.  Frances CD, Noguchi H, Massie BM, et al. Are we inhibited? Renal insufficiency should not preclude the use of ACE inhibitors for patients with myocardial infarction and depressed left ventricular function. Arch Intern Med 2000; 160:2645. 

3. Evans M, Carrero JJ, Szummer K, et al. Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients With Renal Dysfunction. J Am Coll Cardiol 2016; 67:1687.