Renal Artery Stenosis Medication

Updated: Aug 05, 2016
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Medication

Medication Summary

The general approach to therapy of ischemic nephropathy involves control of hypertension, preferably with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Unfortunately, these two classes of drugs may lead to increased serum creatinine levels and hyperkalemia, limiting their utility. In this case, calcium channel blockers are likely the most useful and best-tolerated agents.

Initiate strict control of serum cholesterol, which usually requires the use of statins, as with all conditions associated with atherosclerosis. A study by Bianchi et al suggested that statins, in addition to ACE inhibitors and ARBs, may reduce proteinuria and slow the progression of kidney disease. [47]

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Angiotensin-converting enzyme inhibitors

Class Summary

These agents decrease aldosterone secretion.

Captopril (Capoten)

Parent compound of this class of medications. Sulfhydryl group associated with proteinuria and neutropenia when used at high doses. Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

Enalapril (Vasotec)

One example of this class of compounds. Similar precautions to captopril with respect to potential increase in potassium and creatinine. Major adverse effect is dry cough. Newer and, occasionally, better tolerated than parent compound. Many variations that allow for once-daily dosing and better tissue ACE inhibition.

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Angiotensin II receptor antagonists

Class Summary

Useful for hypertension and heart failure in patients who are intolerant of ACE inhibitors. Many alternative compounds exist with few significant clinical differences.

Losartan (Cozaar)

Initial compound in class to gain approval. Useful for treatment of hypertension and heart failure in patients who are intolerant of ACE inhibitors. Many alternative compounds exist with few significant clinical differences. Nonpeptide angiotensin II receptor antagonist that blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II. May induce a more complete inhibition of the renin-angiotensin system than ACE inhibitors, does not affect the response to bradykinin, and is less likely to be associated with cough and angioedema. For patients unable to tolerate ACE inhibitors.

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HMG-CoA reductase inhibitors

Class Summary

Adjunct to diet to reduce total and LDL cholesterol in patients with hypercholesterolemia. Also lower triglycerides.

Atorvastatin (Lipitor)

One of many compounds with comparable efficacy and adverse effect profiles. Inhibits HMG-CoA reductase, which, in turn, inhibits cholesterol synthesis and increases cholesterol metabolism.

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