Side effects of ACE inhibitors and ARBs on the kidney
What are the major side effects on the kidney of ACE inhibitors and ARBs?
ACE inhibitors and ARBs are associated with AKI and hyperkalemia. These effects are due to inhibition of angiotensin II production by ACE inhibitors or competitive antagonism of the angiotensin II receptor by ARBs.
This results in loss of angiotensin II–induced efferent arteriolar tone, leading to a drop in glomerular filtration fraction and GFR. The efferent arteriolal vasodilation reduces intraglomerular hypertension (and pressure-related injury) and maintains perfusion (and oxygenation) of the peritubular capillaries.
Hyperkalemia occurs due to reduced adrenal aldosterone synthesis from decreased angiotensin II production/receptor binding.
Acute Interstitial Nephritis is a rare complication of ACE inhibitors.