Re: [igan]Effects of ACE inhibitors on the kidneys

[Guest guest]

Hi ,

It is a matter of balancing both. While the creatinine can be elevated by

ACE inhibitors, reducing BP and protein has a protective measure on the kidneys.

Overall, high BP is harder on your kidneys, and in fact a common reason for

kidney failure, than a slight increase in creatinine.

On how often your labs get checked, it depends on the Neph how often your

blood is checked. I do not recall what your kidney function is, but in the

early 20-25 years, I had mine checked every 6 months or so. For the past couple

of years I have had mine checked monthly partially because of the Procrit and

partially because my function has dropped below 20%.

I hope your car situation gets taken care of soon!

In a message dated 12/31/2004 6:46:58 AM Pacific Standard Time,

scalanosh@... writes:

> Pierre wrote:

>

> " You know, while an ACE inhibitor does reduce

> proteinuria, it also worsens kidney function a bit as it does it. In some

> patients, hopefully a very small minority, it can worsen kidney function by

> more than 30%, to the point that some people actually have to stop taking

> it. Some people have actually had acute kidney failure from taking an ACE

> inhibitor. Sometimes, it might be appropriate to see how a patient does

> without the drug, if something like this might be suspected. Sometimes it

> needs to be stopped because it just raises potassium too much. "

>

>

> that doesn't sound too good!

> When you stop the ACE inhibitor does your kidney function go back to normal,

> if it's made you lose kidney function?

> How often should you have blood work for this after starting the med?

> I've had to put off my neph appointment until I have a reliable car- I do

> know that in a month's time after starting Benicar (ARB) my creatinine went

> from 0.8 to 1.1 (still normal).

> But is the worsening of the kidney function worth it? Wouldn't it do more

> damage in the long run? I've had alot of proteinuria but always around perfect

> kidney function...

>

> -beth

[Guest guest]

Sorry ,

You stated your kidney function right in the email, but I hit send before I

caught my mistake. Even at a normal creatinine, ACE inhibitors still have a

renal protective measure and are really standard treatment for IgAN even with

normal creatinine.

In a message dated 12/31/2004 6:46:58 AM Pacific Standard Time,

scalanosh@... writes:

>

> Pierre wrote:

>

> " You know, while an ACE inhibitor does reduce

> proteinuria, it also worsens kidney function a bit as it does it. In some

> patients, hopefully a very small minority, it can worsen kidney function by

> more than 30%, to the point that some people actually have to stop taking

> it. Some people have actually had acute kidney failure from taking an ACE

> inhibitor. Sometimes, it might be appropriate to see how a patient does

> without the drug, if something like this might be suspected. Sometimes it

> needs to be stopped because it just raises potassium too much. "

>

>

> that doesn't sound too good!

> When you stop the ACE inhibitor does your kidney function go back to normal,

> if it's made you lose kidney function?

> How often should you have blood work for this after starting the med?

> I've had to put off my neph appointment until I have a reliable car- I do

> know that in a month's time after starting Benicar (ARB) my creatinine went

> from 0.8 to 1.1 (still normal).

> But is the worsening of the kidney function worth it? Wouldn't it do more

> damage in the long run? I've had alot of proteinuria but always around perfect

> kidney function...

>

> -beth

[Guest guest]

Pierre,

A much better explanation! I should have read ahead before I responded to

.

Another example of the master at work :-)

Thanks Pierre for another " keeper "

In a message dated 12/31/2004 7:54:28 AM Pacific Standard Time,

pgl-groups@... writes:

> Hi beth

>

> No, it's perfectly Ok, as far as is known. There have been plenty of studies

> and clinical trials about ACE inhibitors and kidney disease. The benefits

> are pretty clear (unlike fish oil, prednisone in some cases, etc.), and at

> this point in time, they are considered to easily outweigh any risks. As

> with any drug, there can be adverse effects. Acute kidney failure would be a

> pretty major adverse effect. A rise in potassium to dangerous levels would

> be an adverse effect..

>

> However, what happens for most people is that the ACE inhibitor lowers the

> pressure at which the blood flows through the glomeruli (the filters in the

> kidneys). Less pressure = less filtering (just like if you turn the tap half

> off, there is less pressure in your garden hose, and so less flow of water).

> So, since there is less filtering, it's common for serum creatinine to go up

> a little after starting on one of these drugs (just as if you had reduced

> your kidney function a little bit - which is in fact what happens).

>

> For the vast majority of people, this increase is meaningless, and

> completely harmless, because the benefits of using an ACE inhibitor far

> outweigh any insignificant decrease in glomerular filtration rate. If you

> were to stop the drug, the serum creatinine would go back down to where it

> was before. There is no permanent damage. In this case, the blood pressure

> inside the filters goes back up, and so glomerular filtration rate goes up

> correspondingly. But, the thing is, the higher blood pressure is more

> harmful to your kidneys' filters than the slight loss of kidney function

> that is caused by the ACE inhibitor. So, this is why going from 0.8 to 1.1

> after starting it is totally insignificant - nothing to worry about at all.

>

> Our members always seem to have proteinuria more in mind than anything else,

> but elevated blood pressure is much more damaging to your kidneys in the

> long run. It causes kidney failure on its own, on top of what the IgAN

> itself is doing to you. Proteinuria is also not a good thing of course, so,

> a drug that lowers blood pressure right in the kidneys themselves, and on

> top of that, also lowers proteinuria is a pretty good deal.

>

> There is some evidence that even though your overall blood pressure might be

> perfectly normal, with kidney disease, it might actually be elevated within

> your glomeruli. This is called " intraglomerular pressure " . We don't know for

> sure, but this could be why ACE inhibitors seem to help even people who

> don't actually have high blood pressure.

>

> Everything I said about ACE inhibitors applies almost exactly the same to

> ARB's like Benicar, Avapro, Cozaar, Diovan. They work in a very similar

> way - just at a slightly different level within what we call the

> " renin-angiotensin-system " .

>

> To summarize, with the current data we have, a slight loss of kidney

> function from these drugs is clearly offset by the benefits.

>

> Now, because of the possible adverse effects, it's prudent for a doctor to

> follow-up after prescribing one, just in case kidney function or potassium

> might be affected too much. Depending on how long the doctor has known your

> medical history, this follow-up could be 2 weeks, 3 weeks, a month, a couple

> of months. My pre-dialysis nephrologist always saw me in a couple of months

> whenever she changed BP med or dosage. If she didn't, it would be longer,

> more like 6 months.

>

> I hope I've explained that adequately, without being too technical.

>

> Pierre

[Guest guest]

Pierre wrote:

" You know, while an ACE inhibitor does reduce

proteinuria, it also worsens kidney function a bit as it does it. In some

patients, hopefully a very small minority, it can worsen kidney function by

more than 30%, to the point that some people actually have to stop taking

it. Some people have actually had acute kidney failure from taking an ACE

inhibitor. Sometimes, it might be appropriate to see how a patient does

without the drug, if something like this might be suspected. Sometimes it

needs to be stopped because it just raises potassium too much. "

that doesn't sound too good!

When you stop the ACE inhibitor does your kidney function go back to normal, if

it's made you lose kidney function?

How often should you have blood work for this after starting the med?

I've had to put off my neph appointment until I have a reliable car- I do know

that in a month's time after starting Benicar (ARB) my creatinine went from 0.8

to 1.1 (still normal).

But is the worsening of the kidney function worth it? Wouldn't it do more damage

in the long run? I've had alot of proteinuria but always around perfect kidney

function...

-beth

[Guest guest]

Hi beth

No, it's perfectly Ok, as far as is known. There have been plenty of studies

and clinical trials about ACE inhibitors and kidney disease. The benefits

are pretty clear (unlike fish oil, prednisone in some cases, etc.), and at

this point in time, they are considered to easily outweigh any risks. As

with any drug, there can be adverse effects. Acute kidney failure would be a

pretty major adverse effect. A rise in potassium to dangerous levels would

be an adverse effect..

However, what happens for most people is that the ACE inhibitor lowers the

pressure at which the blood flows through the glomeruli (the filters in the

kidneys). Less pressure = less filtering (just like if you turn the tap half

off, there is less pressure in your garden hose, and so less flow of water).

So, since there is less filtering, it's common for serum creatinine to go up

a little after starting on one of these drugs (just as if you had reduced

your kidney function a little bit - which is in fact what happens).

For the vast majority of people, this increase is meaningless, and

completely harmless, because the benefits of using an ACE inhibitor far

outweigh any insignificant decrease in glomerular filtration rate. If you

were to stop the drug, the serum creatinine would go back down to where it

was before. There is no permanent damage. In this case, the blood pressure

inside the filters goes back up, and so glomerular filtration rate goes up

correspondingly. But, the thing is, the higher blood pressure is more

harmful to your kidneys' filters than the slight loss of kidney function

that is caused by the ACE inhibitor. So, this is why going from 0.8 to 1.1

after starting it is totally insignificant - nothing to worry about at all.

Our members always seem to have proteinuria more in mind than anything else,

but elevated blood pressure is much more damaging to your kidneys in the

long run. It causes kidney failure on its own, on top of what the IgAN

itself is doing to you. Proteinuria is also not a good thing of course, so,

a drug that lowers blood pressure right in the kidneys themselves, and on

top of that, also lowers proteinuria is a pretty good deal.

There is some evidence that even though your overall blood pressure might be

perfectly normal, with kidney disease, it might actually be elevated within

your glomeruli. This is called " intraglomerular pressure " . We don't know for

sure, but this could be why ACE inhibitors seem to help even people who

don't actually have high blood pressure.

Everything I said about ACE inhibitors applies almost exactly the same to

ARB's like Benicar, Avapro, Cozaar, Diovan. They work in a very similar

way - just at a slightly different level within what we call the

" renin-angiotensin-system " .

To summarize, with the current data we have, a slight loss of kidney

function from these drugs is clearly offset by the benefits.

Now, because of the possible adverse effects, it's prudent for a doctor to

follow-up after prescribing one, just in case kidney function or potassium

might be affected too much. Depending on how long the doctor has known your

medical history, this follow-up could be 2 weeks, 3 weeks, a month, a couple

of months. My pre-dialysis nephrologist always saw me in a couple of months

whenever she changed BP med or dosage. If she didn't, it would be longer,

more like 6 months.

I hope I've explained that adequately, without being too technical.

Pierre

Re: Effects of ACE inhibitors on the kidneys

>

> Pierre wrote:

>

> " You know, while an ACE inhibitor does reduce

> proteinuria, it also worsens kidney function a bit as it does it. In some

> patients, hopefully a very small minority, it can worsen kidney function

by

> more than 30%, to the point that some people actually have to stop taking

> it. Some people have actually had acute kidney failure from taking an ACE

> inhibitor. Sometimes, it might be appropriate to see how a patient does

> without the drug, if something like this might be suspected. Sometimes it

> needs to be stopped because it just raises potassium too much. "

>

>

> that doesn't sound too good!

> When you stop the ACE inhibitor does your kidney function go back to

normal, if it's made you lose kidney function?

> How often should you have blood work for this after starting the med?

> I've had to put off my neph appointment until I have a reliable car- I do

know that in a month's time after starting Benicar (ARB) my creatinine went

from 0.8 to 1.1 (still normal).

> But is the worsening of the kidney function worth it? Wouldn't it do more

damage in the long run? I've had alot of proteinuria but always around

perfect kidney function...

>

> -beth

>

[Guest guest]

Hi beth

No, it's perfectly Ok, as far as is known. There have been plenty of studies

and clinical trials about ACE inhibitors and kidney disease. The benefits

are pretty clear (unlike fish oil, prednisone in some cases, etc.), and at

this point in time, they are considered to easily outweigh any risks. As

with any drug, there can be adverse effects. Acute kidney failure would be a

pretty major adverse effect. A rise in potassium to dangerous levels would

be an adverse effect..

However, what happens for most people is that the ACE inhibitor lowers the

pressure at which the blood flows through the glomeruli (the filters in the

kidneys). Less pressure = less filtering (just like if you turn the tap half

off, there is less pressure in your garden hose, and so less flow of water).

So, since there is less filtering, it's common for serum creatinine to go up

a little after starting on one of these drugs (just as if you had reduced

your kidney function a little bit - which is in fact what happens).

For the vast majority of people, this increase is meaningless, and

completely harmless, because the benefits of using an ACE inhibitor far

outweigh any insignificant decrease in glomerular filtration rate. If you

were to stop the drug, the serum creatinine would go back down to where it

was before. There is no permanent damage. In this case, the blood pressure

inside the filters goes back up, and so glomerular filtration rate goes up

correspondingly. But, the thing is, the higher blood pressure is more

harmful to your kidneys' filters than the slight loss of kidney function

that is caused by the ACE inhibitor. So, this is why going from 0.8 to 1.1

after starting it is totally insignificant - nothing to worry about at all.

Our members always seem to have proteinuria more in mind than anything else,

but elevated blood pressure is much more damaging to your kidneys in the

long run. It causes kidney failure on its own, on top of what the IgAN

itself is doing to you. Proteinuria is also not a good thing of course, so,

a drug that lowers blood pressure right in the kidneys themselves, and on

top of that, also lowers proteinuria is a pretty good deal.

There is some evidence that even though your overall blood pressure might be

perfectly normal, with kidney disease, it might actually be elevated within

your glomeruli. This is called " intraglomerular pressure " . We don't know for

sure, but this could be why ACE inhibitors seem to help even people who

don't actually have high blood pressure.

Everything I said about ACE inhibitors applies almost exactly the same to

ARB's like Benicar, Avapro, Cozaar, Diovan. They work in a very similar

way - just at a slightly different level within what we call the

" renin-angiotensin-system " .

To summarize, with the current data we have, a slight loss of kidney

function from these drugs is clearly offset by the benefits.

Now, because of the possible adverse effects, it's prudent for a doctor to

follow-up after prescribing one, just in case kidney function or potassium

might be affected too much. Depending on how long the doctor has known your

medical history, this follow-up could be 2 weeks, 3 weeks, a month, a couple

of months. My pre-dialysis nephrologist always saw me in a couple of months

whenever she changed BP med or dosage. If she didn't, it would be longer,

more like 6 months.

I hope I've explained that adequately, without being too technical.

Pierre

Re: Effects of ACE inhibitors on the kidneys

>

> Pierre wrote:

>

> " You know, while an ACE inhibitor does reduce

> proteinuria, it also worsens kidney function a bit as it does it. In some

> patients, hopefully a very small minority, it can worsen kidney function

by

> more than 30%, to the point that some people actually have to stop taking

> it. Some people have actually had acute kidney failure from taking an ACE

> inhibitor. Sometimes, it might be appropriate to see how a patient does

> without the drug, if something like this might be suspected. Sometimes it

> needs to be stopped because it just raises potassium too much. "

>

>

> that doesn't sound too good!

> When you stop the ACE inhibitor does your kidney function go back to

normal, if it's made you lose kidney function?

> How often should you have blood work for this after starting the med?

> I've had to put off my neph appointment until I have a reliable car- I do

know that in a month's time after starting Benicar (ARB) my creatinine went

from 0.8 to 1.1 (still normal).

> But is the worsening of the kidney function worth it? Wouldn't it do more

damage in the long run? I've had alot of proteinuria but always around

perfect kidney function...

>

> -beth

>

[Guest guest]

Hi beth

No, it's perfectly Ok, as far as is known. There have been plenty of studies

and clinical trials about ACE inhibitors and kidney disease. The benefits

are pretty clear (unlike fish oil, prednisone in some cases, etc.), and at

this point in time, they are considered to easily outweigh any risks. As

with any drug, there can be adverse effects. Acute kidney failure would be a

pretty major adverse effect. A rise in potassium to dangerous levels would

be an adverse effect..

However, what happens for most people is that the ACE inhibitor lowers the

pressure at which the blood flows through the glomeruli (the filters in the

kidneys). Less pressure = less filtering (just like if you turn the tap half

off, there is less pressure in your garden hose, and so less flow of water).

So, since there is less filtering, it's common for serum creatinine to go up

a little after starting on one of these drugs (just as if you had reduced

your kidney function a little bit - which is in fact what happens).

For the vast majority of people, this increase is meaningless, and

completely harmless, because the benefits of using an ACE inhibitor far

outweigh any insignificant decrease in glomerular filtration rate. If you

were to stop the drug, the serum creatinine would go back down to where it

was before. There is no permanent damage. In this case, the blood pressure

inside the filters goes back up, and so glomerular filtration rate goes up

correspondingly. But, the thing is, the higher blood pressure is more

harmful to your kidneys' filters than the slight loss of kidney function

that is caused by the ACE inhibitor. So, this is why going from 0.8 to 1.1

after starting it is totally insignificant - nothing to worry about at all.

Our members always seem to have proteinuria more in mind than anything else,

but elevated blood pressure is much more damaging to your kidneys in the

long run. It causes kidney failure on its own, on top of what the IgAN

itself is doing to you. Proteinuria is also not a good thing of course, so,

a drug that lowers blood pressure right in the kidneys themselves, and on

top of that, also lowers proteinuria is a pretty good deal.

There is some evidence that even though your overall blood pressure might be

perfectly normal, with kidney disease, it might actually be elevated within

your glomeruli. This is called " intraglomerular pressure " . We don't know for

sure, but this could be why ACE inhibitors seem to help even people who

don't actually have high blood pressure.

Everything I said about ACE inhibitors applies almost exactly the same to

ARB's like Benicar, Avapro, Cozaar, Diovan. They work in a very similar

way - just at a slightly different level within what we call the

" renin-angiotensin-system " .

To summarize, with the current data we have, a slight loss of kidney

function from these drugs is clearly offset by the benefits.

Now, because of the possible adverse effects, it's prudent for a doctor to

follow-up after prescribing one, just in case kidney function or potassium

might be affected too much. Depending on how long the doctor has known your

medical history, this follow-up could be 2 weeks, 3 weeks, a month, a couple

of months. My pre-dialysis nephrologist always saw me in a couple of months

whenever she changed BP med or dosage. If she didn't, it would be longer,

more like 6 months.

I hope I've explained that adequately, without being too technical.

Pierre

Re: Effects of ACE inhibitors on the kidneys

>

> Pierre wrote:

>

> " You know, while an ACE inhibitor does reduce

> proteinuria, it also worsens kidney function a bit as it does it. In some

> patients, hopefully a very small minority, it can worsen kidney function

by

> more than 30%, to the point that some people actually have to stop taking

> it. Some people have actually had acute kidney failure from taking an ACE

> inhibitor. Sometimes, it might be appropriate to see how a patient does

> without the drug, if something like this might be suspected. Sometimes it

> needs to be stopped because it just raises potassium too much. "

>

>

> that doesn't sound too good!

> When you stop the ACE inhibitor does your kidney function go back to

normal, if it's made you lose kidney function?

> How often should you have blood work for this after starting the med?

> I've had to put off my neph appointment until I have a reliable car- I do

know that in a month's time after starting Benicar (ARB) my creatinine went

from 0.8 to 1.1 (still normal).

> But is the worsening of the kidney function worth it? Wouldn't it do more

damage in the long run? I've had alot of proteinuria but always around

perfect kidney function...

>

> -beth

>

[Guest guest]

Hi ,

I just wanted to second what Pierre said. When was first diagnosed,

he was put on a drug regimen (including cyclosporine and lisinopril) that

caused his creatinine to more than double (in kids you can frequently say

things like that - especially when an increase of 0.5 will double the

" normal " value!). The docs came up with three different hypotheses - and

kept him on the protocol (which failed for other reasons, not related to the

creatinine increase). It was generally agreed at the time, that the

overall effect was for the greater good of the kidneys - especially since

they were no longer hyperfiltrating!). As soon as the drug protocol ended,

creatinine and BUN normalized. At one time, we did stop ace inhibitor

altogether because the docs thought it might be related to 's anemia

(it wasn't). I ended making a case for them to put him back on it, since it

worked so well with respect to hypertension.

Cy

Re: Effects of ACE inhibitors on the kidneys

>

>

> >

> > Pierre wrote:

> >

> > " You know, while an ACE inhibitor does reduce

> > proteinuria, it also worsens kidney function a bit as it does it. In

some

> > patients, hopefully a very small minority, it can worsen kidney function

> by

> > more than 30%, to the point that some people actually have to stop

taking

> > it. Some people have actually had acute kidney failure from taking an

ACE

> > inhibitor. Sometimes, it might be appropriate to see how a patient does

> > without the drug, if something like this might be suspected. Sometimes

it

> > needs to be stopped because it just raises potassium too much. "

> >

> >

> > that doesn't sound too good!

> > When you stop the ACE inhibitor does your kidney function go back to

> normal, if it's made you lose kidney function?

> > How often should you have blood work for this after starting the med?

> > I've had to put off my neph appointment until I have a reliable car- I

do

> know that in a month's time after starting Benicar (ARB) my creatinine

went

> from 0.8 to 1.1 (still normal).

> > But is the worsening of the kidney function worth it? Wouldn't it do

more

> damage in the long run? I've had alot of proteinuria but always around

> perfect kidney function...

> >

> > -beth

> >

>

>

>

>

>

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