USMLE (Fach) / Pharmacology - Renal (Lektion)

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Inhibit ACE → ↓ AT II → ↓ GFR by preventing constriction of efferent arterioles. ↑ renin due to loss of negative feedback.
Inhibition of ACE also prevents inactivation of bradykinin, a potent vasodilator. 

Use:
- Hypertension
- HF (↓ mortality)
- Proteinuria
- Diabetic nephropathy
- Prevent unfavorable heart remodeling as a result of chronic hypertension.
- In chronic kidney disease (eg, diabetic nephropathy), ↓ intraglomerular pressure, slowing GBM thickening.

Adverse effects:
- Cough and angioedema (both due to ↑ bradykinin; contraindicated in C1 esterase inhibitor deficiency)
- Teratogen (fatal renal malformations)
- ↑ creatinine (↓ GFR)
- Hyperkalemia
- Hypotension
- Used with caution in bilateral renal artery stenosis because ACE inhibitors will further ↓ GFR → renal failure.

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