Lisinopril side effects on kidneys
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Lisinopril Side Effects on Kidneys
Introduction to Lisinopril and Kidney Function
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for managing hypertension and heart failure. It is also used to protect kidney function in patients with diabetic nephropathy. However, its effects on the kidneys, both beneficial and adverse, are a subject of extensive research.
Renoprotective Effects of Lisinopril
Reduction in Proteinuria
One of the significant benefits of lisinopril is its ability to reduce proteinuria, a condition characterized by excess protein in the urine, which is a marker of kidney damage. Studies have shown that lisinopril significantly decreases proteinuria in various patient groups, including those with diabetic nephropathy and chronic allograft nephropathy 128. This reduction in proteinuria is crucial as it helps in slowing the progression of kidney disease.
Stabilization of Glomerular Filtration Rate (GFR)
Lisinopril has been observed to stabilize the glomerular filtration rate (GFR), which is a measure of kidney function. In patients with diabetic nephropathy, lisinopril treatment resulted in a slower decline in GFR compared to other antihypertensive treatments like atenolol 35. This stabilization is essential in preventing the progression to end-stage renal disease.
Improvement in Renal Hemodynamics
Lisinopril improves renal hemodynamics by reducing renal vascular resistance and increasing renal plasma flow. This effect helps in maintaining better kidney function over time 27. Additionally, in patients with chronic allograft nephropathy, lisinopril was shown to reduce renal proximal tubular polypeptide catabolism, suggesting a protective effect on the kidney's filtering units .
Adverse Effects on Kidney Function
Initial Decline in GFR
Despite its long-term benefits, lisinopril can cause an initial decline in GFR. This biphasic response, characterized by an initial rapid decline followed by a slower, sustained decline, has been documented in several studies 13. This initial drop is usually transient and is followed by stabilization or improvement in kidney function.
Risk of Hyperkalemia
Lisinopril can lead to an increase in serum potassium levels, a condition known as hyperkalemia. While this side effect is generally mild, it can become clinically significant, especially in patients with pre-existing kidney conditions or those taking other medications that increase potassium levels 28.
Impact on Renal Transplant Patients
In renal transplant recipients, the effects of lisinopril are mixed. While it effectively reduces proteinuria and improves renal hemodynamics, it does not significantly outperform other antihypertensive agents like nifedipine in improving long-term kidney function . Additionally, careful monitoring is required to avoid potential adverse effects such as hyperkalemia and a decline in GFR.
Conclusion
Lisinopril offers substantial renoprotective benefits, particularly in reducing proteinuria and stabilizing GFR in patients with diabetic nephropathy and chronic kidney disease. However, its use requires careful monitoring due to potential adverse effects like an initial decline in GFR and hyperkalemia. Overall, lisinopril remains a valuable medication in managing kidney-related complications in hypertensive and diabetic patients, provided its administration is closely supervised.
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