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Angiotensin I converting enzyme inhibitors and angiotensin II receptor antagonists

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Clinical Nephrotoxins

Summary

Soon after the introduction of ACEI much attention was given to their renal side effects. This initiated a lot of research, especially because hypertension frequently is present in patients with renal vascular and/or parenchymal disease and the use of ACEI therefore was prompted in such patient groups. In the early eighties nephrotic syndrome due to a membranous glomerulopathy was described in association with the use of captopril. Further detailed studies showed this side effect to be related to the very high doses that at that time were used in patients with renal disease. More common is the acute renal functional deterioration that may occur during ACEI in certain groups, such as in patients with renovascular hypertension, in patients with severe heart failure and in patients with severe renal failure, especially in case of volume depletion. However, this fall in filtration is reversible after withdrawal of the drug or after volume repletion. This finding of a renal hemodynamically mediated fall in intra-glomerular capillary pressure prompted studies that provided evidence of an antiproteinuric and renoprotective effect of this class of drugs. Close monitoring of side effects of drugs such as ACEI along with a basic understanding of the role of the renin angiotensin system in patients with renal diseases opens new perspectives for the treatment of such patients.

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Authors and Affiliations

  1. University of Groningen, The Netherlands

    Paul E. De Jong

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  1. Paul E. De Jong
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Editors and Affiliations

  1. Department of Nephrology and Hypertension, University of Antwerp, Belgium

    Marc E. de Broe

  2. Department of Medicine, The Oregon Health Sciences University, Portland, Oregon, USA

    George A. Porter

  3. Northwest Renal Clinic, Legacy Good Samaritan Hospital, Portland, Oregon, USA

    William M. Bennett

  4. Department of Nephrology and Hypertension, University of Antwerp, Belgium

    Gert A. Verpooten

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De Jong, P.E. (2003). Angiotensin I converting enzyme inhibitors and angiotensin II receptor antagonists. In: de Broe, M.E., Porter, G.A., Bennett, W.M., Verpooten, G.A. (eds) Clinical Nephrotoxins. Springer, Dordrecht. https://doi.org/10.1007/1-4020-2586-6_16

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  • DOI: https://doi.org/10.1007/1-4020-2586-6_16

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