Renal effects of angiotensin-converting enzyme inhibition in congestive heart failure.

摘要: Some studies report that inhibition of angiotensin-converting enzyme (ACE) improves renal function in patients with congestive heart failure, whereas others deterioration is a frequent complication treatment ACE inhibitors. This article explores the mechanisms by which antagonism renin-angiotensin system kidney some while causing harm others. may alter blood flow, glomerular perfusion pressure, basement membrane activity and tubular both directly indirectly. In most patients, maintained as other neurohormonal compensate for negative effects permit positive (such improved flow) to predominate. However, when physiologic characteristics or iatrogenic interventions volume reduction prostaglandin inhibition) limit effectiveness compensation maintain autoregulation, clinically important occur. An understanding inhibitors permits their safe effective use failure.