Renal considerations in angiotensin converting enzyme inhibitor therapy - A statement for healthcare professionals from the council on the kidney in cardiovascular disease and the council for high blood pressure research of the American Heart Association

The use of ACE inhibitors in patients with CHF, hypertension, and chronic nephropathies is often a double-edged sword. As long as renal perfusion pressure is adequate and volume depletion is not severe, ACE inhibitors can improve renal hemodynamics so that an improvement in renal salt excretion can be achieved. However, because Ang II is necessary for maintenance of GFR during states of significant volume depletion, these agents also can cause GFR to decrease rapidly, with consequent oliguric or anuric renal failure. ACE inhibitors can generally be safely restarted after resolution of an ARF episode, particularly if the underlying conditions having predisposed to the episode can be rectified. The principles of ACE inhibitor therapy are summarized in Table 3.